Mixed Deck — All CSR Topics Flashcards

A renal dietitian sets a follow-up goal with a patient, but the patient never returns for the scheduled visit. The MOST proactive response is to:

Answer: Conduct an outreach call to assess barriers to attendance and offer alternative visit formats

Proactive outreach to identify barriers (transportation, work schedule, cost) prevents dropout and supports patient-centered care.

A CKD patient's dietary recall reveals high intake of star fruit (carambola). Which neurological risk must the dietitian urgently communicate regarding this food?

Answer: Caramboxin toxin causing encephalopathy and seizures in CKD

Star fruit contains caramboxin, a neurotoxin normally cleared by healthy kidneys; in CKD patients it accumulates and causes intractable hiccups, seizures, and encephalopathy — even in small amounts.

A renal dietitian is using Subjective Global Assessment (SGA) for a dialysis patient. Which component is assessed in SGA?

Answer: Dietary intake history and physical examination findings

SGA is a clinical tool that combines dietary history (weight changes, appetite, dietary intake changes, GI symptoms) with physical examination findings (subcutaneous fat, muscle wasting, edema) to categorize nutritional status as A (well-nourished), B (mild-moderate malnutrition), or C (severe malnutrition).

A kidney transplant patient develops new-onset hypertension and hyperlipidemia at 6 months post-transplant. Aside from antihypertensive medications, which dietary intervention has evidence for improving both conditions?

Answer: Mediterranean-style diet with olive oil, fish, legumes, vegetables, and reduced sodium (< 2.3 g/day)

The Mediterranean diet reduces blood pressure (via sodium/potassium balance, anti-inflammatory polyphenols) and improves lipid profiles (olive oil reduces LDL, increases HDL; omega-3 from fish reduces triglycerides) — both validated benefits in transplant patients.

A peritoneal dialysis patient takes sevelamer with meals yet has persistently elevated serum phosphorus. Which assessment question should the renal dietitian ask FIRST?

Answer: 'Are you taking your phosphate binders WITH each meal and snack, not before or after?'

Phosphate binders must be co-ingested with food to physically bind dietary phosphate in the GI tract; timing errors (taking binders before or after meals) are the most common reason for treatment failure before adherence is assumed.

Which serum biomarker is considered the BEST validated indicator of chronic inflammation rather than nutritional status in dialysis patients?

Answer: C-reactive protein (CRP)

CRP is a direct acute-phase reactant that reliably reflects inflammatory status, whereas albumin and prealbumin are negative acute-phase reactants also affected by inflammation.

According to the protein balance concept, a stable HD patient with nPCR (normalized protein catabolic rate) of 0.8 g/kg/day is BEST described as:

Answer: Having inadequate dietary protein intake, at risk for negative nitrogen balance and protein-energy wasting

In stable HD patients, nPCR approximates dietary protein intake. nPCR of 0.8 g/kg/day falls below the KDOQI recommendation of ≥ 1.2 g/kg/day, indicating inadequate protein intake and risk for negative nitrogen balance and PEW.

Subjective Global Assessment (SGA) evaluates nutritional status in dialysis patients by examining which components?

Answer: Dietary history, weight changes, and physical signs of malnutrition

SGA assesses nutritional status by combining dietary history, recent weight changes, and physical signs of fat or muscle loss.

A CKD patient on a 2 g/day sodium diet reports following the restriction carefully but continues to have significant fluid retention. The dietitian should investigate which commonly overlooked source of sodium?

Answer: Medications: sodium-containing medications including sodium bicarbonate tablets, effervescent vitamin C, some antacids, IV normal saline infusions, and oral rehydration salts — can provide 1–3+ g/day of 'hidden' sodium not accounted for in dietary recall

Many medications contain significant sodium: sodium bicarbonate supplements (each 650 mg tablet = ~175 mg sodium), effervescent tablets (vitamin C, antacids), some PPIs formulated as sodium salts. These medication-derived sodium sources are not captured in dietary food recall but contribute meaningfully to total daily sodium intake.

How should an CSR professional handle a situation outside their scope of competency?

Answer: Recognize limitations and refer to appropriate specialists

Professional responsibility requires recognizing one's limitations and referring to qualified specialists when a situation exceeds competency boundaries.

A dietitian reviews labs for a CKD patient taking herbal supplements. Elevated serum potassium with no dietary explanation is found. Which supplement class poses the greatest hyperkalemia risk?

Answer: Aloe vera and dandelion root

Aloe vera and dandelion are naturally high in potassium and are commonly used herbal remedies that significantly raise potassium intake in CKD patients.

What does the ethical principle of beneficence entail in renal nutrition care?

Answer: Acting in the patient’s best interest.

Beneficence is an ethical principle that requires healthcare professionals to act in ways that benefit the patient and promote their well-being. In renal nutrition care, this means providing interventions and advice that are intended to improve the patient's health, prevent harm, and optimize their nutritional status, always with their best interests as the primary goal.

In chronic kidney disease, decreased production of which hormone by the peritubular cells leads to anemia?

Answer: Erythropoietin

Erythropoietin (EPO) is produced by peritubular interstitial cells in the renal cortex. CKD leads to fibrosis and loss of these cells, reducing EPO production and causing normocytic normochromic anemia.

The RAAS (renin-angiotensin-aldosterone system) plays a central role in edema formation in CKD. Which dietary intervention has the MOST direct effect on suppressing RAAS activation in CKD patients?

Answer: Sodium restriction, which reduces volume stimulus for RAAS activation and enhances the antiproteinuric and antihypertensive effects of ACE inhibitors/ARBs

Volume depletion of any cause activates RAAS. Sodium restriction reduces extracellular volume and blunts the volume-dependent RAAS stimulus. It also dramatically enhances the efficacy of ACE inhibitors/ARBs by reducing sodium-angiotensin interaction, lowering both blood pressure and proteinuria.

What is the benefit of interdisciplinary collaboration in Board Certified Specialist in Renal Nutrition practice?

Answer: It brings diverse expertise and perspectives that improve outcomes

Interdisciplinary collaboration enhances Board Certified Specialist in Renal Nutrition practice by combining diverse expertise, perspectives, and skills for more comprehensive and effective outcomes.

In a child with nephrotic syndrome and severe hypoalbuminemia (albumin 1.8 g/dL), which dietary approach to protein intake is currently recommended?

Answer: Moderate protein intake matching DRI for age (0.8–1.5 g/kg/day depending on age), as high protein does not replete albumin but increases proteinuria and glomerular damage

In nephrotic syndrome, high protein intake does not effectively raise albumin because increased intake is matched by proportionally increased urinary protein losses (increased proteinuria), while worsening glomerular hyperfiltration. Normal DRI-based protein intake with adequate energy is recommended.

Growth hormone resistance in children with CKD is mediated by which mechanism most directly linking uremia to impaired linear growth?

Answer: Uremia-related downregulation of hepatic GH receptor and postreceptor signaling defects (reduced Janus kinase 2/STAT5 activation), leading to low IGF-1 production despite normal or elevated GH levels

CKD causes uremic resistance to GH by downregulating hepatic GH receptors and impairing intracellular GH signaling (JAK2/STAT5 pathway), resulting in low IGF-1 levels despite elevated serum GH. This is the molecular basis for growth failure in pediatric CKD.

In CKD nutrition assessment, 'protein-energy wasting' (PEW) is defined by the ISRNM as requiring criteria from how many of the four diagnostic categories?

Answer: At least three of the four categories

The International Society of Renal Nutrition and Metabolism (ISRNM) defines PEW when criteria from at least 3 of the 4 categories are met: biochemical criteria, low body weight/BMI/fat mass, reduced muscle mass, and low dietary protein or energy intake.

Iron deficiency is common in pediatric CKD patients on erythropoiesis-stimulating agents (ESAs). What is the preferred route of iron supplementation in a child on hemodialysis?

Answer: Intravenous iron sucrose or ferric gluconate administered during hemodialysis sessions, as oral iron has poor absorption and GI side effects in dialysis patients

IV iron (iron sucrose, ferric gluconate) administered during HD sessions provides reliable, predictable iron delivery without GI side effects. Oral iron absorption is impaired by uremia, inflammation, phosphate binders (calcium and non-calcium binders reduce iron absorption), and GI side effects limit adherence in children.

Per KDIGO 2017 recommendations, what is the suggested upper limit for total elemental calcium intake (diet plus supplements) in most adult CKD patients to reduce the risk of hypercalcemia and vascular calcification?

Answer: 2,000 mg/day

KDIGO and NKF/KDOQI guidelines recommend limiting total elemental calcium from all sources (diet and supplements) to no more than 2,000 mg/day, with lower limits (≤1,500 mg/day) often recommended when calcium-based binders are used.