Nutrition for Kidney Health 3rd Year 2nd Semester Flashcards

Question

What is the main dietary change recommended by the KDOQI to reduce net acid production in adults with CKD 1-4? A) Increase dairy intake B) Reduce protein consumption C) Increase intake of fruits and vegetables D) Decrease calcium intake

Answer 1

**Explanation: Correct answer: C) Increase intake of fruits and vegetables. The KDOQI suggests increasing fruit and vegetable intake to reduce net acid production, which can help slow kidney function decline.**

Answer 2

Explanation: Correct answer: B) Oysters. Oysters and other organ meats are high in phosphorus and should be avoided in the renal diet.

Answer 3

Explanation: Correct answer: B) Adjust phosphorus intake to maintain serum phosphate levels in the normal range. The KDOQI recommends dietary adjustments to maintain phosphorus at normal serum levels in CKD patients to avoid complications such as bone disease. Renal Diet - Phosphorus * KDOQI Statement on Phosphorus:  Dietary Phosphorus Amount * In adults with CKD 3-5, we recommend adjusting dietary phosphorus intake to maintain serum phosphate levels in the normal range.  Dietary Phosphorus Source * In adults with CKD 1-5 or post-transplantation, it is reasonable when making decisions about phosphorus restriction to consider the bioavailability of phosphorus sources (e.g. animal, vegetable, additives)

Answer 4

Explanation: Correct answer: B) Homemade low-sodium soups and casseroles. It's recommended to use homemade or low-sodium options in place of processed foods high in sodium, which should be avoided in CKD diets.

Answer 5

Explanation: Correct answer: B) Decreases creatinine and proteinuria. Flaxseed (especially at 30g) has been shown to reduce creatinine levels and proteinuria in patients with Lupus nephritis. **Flax seeds and Renal Diet** * 9 patients with Lupus nephritis and crossover study Ground 15g, 30g or 45g daily for 4 weeks  15g approximately equals 1 tbsp, e.g. 1 tbsp, 2tbsp and 3 tbsp daily * Results  ↓creatinine at 30g and 45g  ↓proteinuria at 30g dose, less extent at 45g dose  Reduced total and LDL cholesterol, blood viscosity at 30g, less extent at 45g  PAF inhibited at all doses  Well tolerated **Explanation:** Flaxseeds help lower creatinine (a waste product that the kidneys normally filter out) through a couple of key actions: Improving kidney filtration: Flaxseeds are thought to make the glomerular basement membrane (the part of the kidney that filters blood) more efficient. This means that the kidneys can filter out waste products, like creatinine, more effectively, which leads to lower creatinine levels in the blood. Reducing blood thickness: Flaxseeds contain omega-3 fatty acids, which help reduce blood viscosity (the thickness of blood). When blood is thinner, it can flow more easily through small blood vessels in the kidneys, which improves kidney function and reduces protein leakage (proteinuria). Decreasing proteinuria: Flaxseeds also contain lignans, which can block a substance called PAF (Platelet-Activating Factor) that contributes to kidney damage and increased proteinuria (excess protein in the urine). By inhibiting PAF, flaxseeds reduce the amount of protein in the urine and help protect the kidneys from further damage. In simpler terms, flaxseeds help the kidneys work more efficiently by improving how they filter blood and reducing the damage that causes kidney dysfunction, ultimately lowering creatinine levels and protecting kidney function.

Answer 6

Explanation: Correct answer: B) Reduces oxidative stress and improves lipid profile. CoQ10 supplementation has been shown to improve lipid profiles, reduce markers of oxidative stress, and decrease serum creatinine in CKD patients. **CoQ10 Renal Diet** * Essential electron transporter in oxidative respiratory chain that generates ATP * Co-Factors: B2, B3, B5, B6, folic acid, b12, vitamin C, SAMe and trace minerals * Plasma coQ10 levels lower in CKD vs controls  With or without dialysis * 21 patients chronic renal failure (Singh et al. 2009)  60mg coQ10 versus placebo for 4 weeks * Results  ↓serum creatinine, BUN  ↑creatinine clearance, urine output  ↑ plasma vitamin A, C and E  ↓ markers of oxidative stress: thiobarbituric acid reactive substances, diene conjugates and malondialdehyde

Answer 7

Correct answer: B) Mediterranean Diet. The KDOQI suggests the Mediterranean diet for patients with CKD 1-5 to help improve lipid profiles and reduce the risk of progression and mortality.

Answer 8

**Answer: a) It decreases oxidative stress and improves cholesterol parameters Explanation:** a) Correct as CoQ10 supplementation has been shown to reduce oxidative stress and improve cholesterol profiles, thereby lowering CVD risk in CKD patients. b) Incorrect as CoQ10 has been observed to decrease serum creatinine rather than increase it. c) Incorrect as CoQ10 does not primarily function to lower blood glucose levels. d) Incorrect as epicardial fat thickness is an indicator of atherosclerosis and is correlated with low CoQ10 levels, not increased by it. **CoQ10 for Renal Diet** * Essential electron transporter in oxidative respiratory chain that generates ATP * Co-Factors: B2, B3, B5, B6, folic acid, b12, vitamin C, SAMe and trace minerals * Plasma coQ10 levels lower in CKD vs controls  With or without dialysis * 21 patients chronic renal failure (Singh et al. 2009)  60mg coQ10 versus placebo for 4 weeks * Results  ↓serum creatinine, BUN  ↑creatinine clearance, urine output  ↑ plasma vitamin A, C and E  ↓ markers of oxidative stress: thiobarbituric acid reactive substances, diene conjugates and malondialdehyde

Answer 9

**Answer: c) CKD patients already have reduced CoQ10 levels, and statins further deplete it. CKD patients have decreased CoQ10 levels, and statins further lower them, increasing the risk of adverse effects. Explanation:** a) Incorrect as CKD patients tend to have lower CoQ10 levels, not higher. b) Incorrect because statins are known to reduce CoQ10 levels. d) Incorrect as statins do not impact creatinine clearance in a way that would cause toxicity. ** CoQ10 and Renal Diet –** * CKD high risk of developing CVD  10-20x ↑ mortality * > cholesterol parameters and ↓oxidative stress with coQ10 supplementation = ↓CVD risk Also, ↓ serum creatinine Epicardial fat thickness * Indicator of atherosclerosis * Correlated with low levels of coQ10 in end stage KI disease patients on dialysis (PMID: 24882509) Statins * CKD patients more susceptible to statin adverse effects  CKD patients often prescribed statins due to CVD risk  CKD patients decreased coQ10 + Statins known to reduce coQ10 levels = Increased risk adverse effects

Answer 10

**Answer: b) It reduces urinal protein, blood urea nitrogen (BUN), and creatinine levels Explanation: b) Correct as studies have shown Cordyceps reduces urinal protein, BUN, and creatinine levels in CKD patients.** a) Incorrect as Cordyceps actually reduces inflammation by modulating the TLR4/NF-kB pathway. c) Incorrect because Cordyceps increases HDL-C, improving lipid profiles. d) Incorrect as Cordyceps has antioxidant properties that reduce oxidative stress. **Cordyceps Renal Diet** * CKD risk is associated with the Toll-like receptor 4/nuclear factor-kappa B (TLR4/NF-κB) signaling pathway * CKD patients were assigned into Cordyceps militaris (COG, 100 mg daily) and placebo (CG) groups. * Cordycepin activity was measured using human embryo kidney cells (HEK293T). * Biochemical indices, the levels of TLR4, NF-κB, cyclooxygenase-2 (COX2), tumor necrosis factor- alpha (TNF-α), and interleukin-1 beta (IL-1β), were measured

Answer 11

**Answer: a) It reduces triglycerides (TG), total cholesterol (TC), and LDL-C while increasing HDL-C a) Correct as studies show Cordyceps reduces TG, TC, and LDL-C while improving HDL-C levels in CKD patients.** Explanation: b) Incorrect as Cordyceps does not increase LDL-C or decrease HDL-C. c) Incorrect as Cordyceps has a documented effect on lipid profiles. d) Incorrect because Cordyceps reduces total cholesterol, not increases it. **Cordyceps Renal Diet** * 3 month trial- cordycepin reduced the levels of urinal protein, blood urea nitrogen (BUN), and creatinine by 36.7%±8.6%, 12.5%±3.2%, and 18.3%±6.6%). * Cordyceps militaris improved lipid profile and redox capacity of CKD patients by reducing the serum levels of TG, TC, and LDL-C by 12.8%±3.6%, 15.7%±4.1%, and 16.5%±4.4% and increasing the HDL-C level by 10.1%±1.4% in the COG group when compared with the CG group, respectively

Answer 12

**Answer: b) It reduces urinal protein, blood urea nitrogen (BUN), and creatinine levelsExplanation: a) Incorrect as Cordyceps actually reduces inflammation by modulating the TLR4/NF-kB pathway.** b) Correct as studies have shown Cordyceps reduces urinal protein, BUN, and creatinine levels in CKD patients. c) Incorrect because Cordyceps increases HDL-C, improving lipid profiles. d) Incorrect as Cordyceps has antioxidant properties that reduce oxidative stress. **Cordyceps for Renal Diet ** * Cordyceps has anti-inflammatory and antioxidant effects * One large-scale study cordyceps lowered creatinine levels in patients with CKD * Others have showed protective effects on kidneys for patients on nephrotoxic medications, with complication of diabetes and with transplants. * May help with renal fibrosis

Answer 13

**Answer: a) Chronic immune dysfunction and stress Explanation: a) Correct as the patient reported frequent illnesses, fatigue, and moderate stress.** b) Incorrect as there is no mention of weight gain. c) Incorrect because her blood pressure was within normal limits. d) Incorrect since diabetes is not mentioned in her case.

Answer 14

**Answer: a) Chronic immune dysfunction, stress, and irregular digestion Explanation:** a) Correct as the patient had been sick frequently for 8 months, reported high stress, and had irregular digestion (BM every other day). b) Incorrect as weight gain was not noted, and she was advised to maintain physical activity. c) Incorrect as her blood pressure was within normal limits. d) Incorrect since diabetes was not a diagnosed issue.

Answer 15

**Answer: a) Zinc citrate, adrenal support, probiotics, vitamin D, and dietary modifications Explanation: a) Correct as the patient was prescribed supplements and dietary changes to support immune function, digestion, and kidney health.** b) Incorrect as no high-dose statin therapy was indicated. c) Incorrect since dialysis and insulin therapy were not necessary. d) Incorrect because protein intake was maintained at 60g/day.

Answer 16

**Answer: a) Improved immune function, digestion, energy, and zinc absorption Explanation: a) Correct as the patient had no recent illnesses, improved digestion (1 BM/day), better energy, and improved zinc tally test results.** b) Incorrect as weight loss and fatigue were not reported. c) Incorrect since her BP remained stable and stress levels were not significantly worse. d) Incorrect as digestion improved rather than worsened.

Answer 17

**Answer: a) To enhance immune function and energy levels Explanation: a) Correct as CoQ10 and Cordyceps were introduced to improve immune function, energy, and kidney health.** b) Incorrect because these supplements do not increase blood pressure. c) Incorrect as they were not prescribed as replacements for medications. d) Incorrect since weight loss was not a treatment goal.

Answer 18

**Answer: a) Energy levels and sleep worsened Explanation: a) Correct as the patient reported decreased energy and poor sleep after stopping supplementation.** b) Incorrect as there is no mention of a significant increase in blood pressure. c) Incorrect since digestion was stable. d) Incorrect because no new kidney disorder was diagnosed.

Answer 19

**Answer: a) Avoid modified corn syrups and increase fruit and vegetable intake Explanation: a) Correct as the recommendations focused on improving diet quality with whole foods and avoiding processed ingredients.** b) Incorrect because processed foods were discouraged. c) Incorrect as adequate hydration was emphasized. d) Incorrect because maintaining protein intake was necessary for overall health.

Answer 20

✅ Correct Answer: A) Vitamin K deficiency affects matrix Gla protein, which inhibits calcification 👉 Why? Matrix Gla protein is vitamin K-dependent, and its deficiency accelerates arterial calcification. ❌ Wrong Answers: B) Vitamin K supplements are harmful in dialysis patients: There is no evidence that vitamin K supplements are harmful. C) Dialysis removes too much vitamin K: Dialysis does not significantly remove vitamin K. D) Vascular calcification is unrelated to dialysis: Dialysis patients have an increased risk of vascular calcification. **Hemodialysis patients tend to have low vitamin K** Many dialysis patients limit their intake of vitamin K-rich foods, such as leafy greens, due to concerns about potassium and phosphorus content. The kidneys play a role in vitamin K metabolism, and chronic kidney disease (CKD) can impact vitamin K status. Dialysis itself does not remove vitamin K directly, but many patients still end up deficient due to dietary restrictions and altered metabolism. **They also tend to have accelerated vascular calcification** Vascular calcification is more common in hemodialysis patients due to factors like: High phosphate levels (which promote calcium deposits in blood vessels) Chronic inflammation Uremia-related mineral imbalances Deficiencies in key vitamins, including vitamin K **Matrix Gla protein inhibits arterial calcification and is vitamin K dependent** Matrix Gla Protein (MGP) is a key inhibitor of vascular calcification. MGP requires vitamin K to become activated (via carboxylation). Without enough vitamin K, MGP remains inactive, leading to increased calcium deposits in arteries and faster progression of vascular calcification. This is why vitamin K deficiency in dialysis patients may contribute to an increased risk of cardiovascular disease.

Answer 21

**✅ Correct Answer: C) It reduces pruritus (itching) 👉 Why? 80% of dialysis patients experience pruritus, and EFAs help improve skin hydration and reduce itching.** ❌ Wrong Answers: A) It prevents vascular calcification: EFAs are not directly involved in vascular calcification. B) It improves dialysis efficiency: EFAs do not impact dialysis filtration efficiency. D) It increases sodium absorption: EFAs do not affect sodium absorption. **EFA’s effect on Hemodialysis** - 80% of dialysis patients experience pruritus which can become severe - Essential fatty acid (EFA) deficiency may contribute - DBT with evening primrose oil (EPO) -10ml bid (640mg of gamma-linolenic acid) showed improvements - Another trial – 1 g bid of EPO showed improvement in pruritus, dryness and erythema - 3g/day fish oil (18% EPA and 12% DHA)- for 20 days improved pruritus

Answer 22

**✅ Correct Answer: A) To prevent Wernicke’s encephalopathy 👉 Why? Thiamine deficiency can lead to Wernicke’s encephalopathy, which causes neurological symptoms such as confusion, vision loss, and dementia.** ❌ Wrong Answers: B) To increase dialysis efficiency: Thiamine does not affect dialysis filtration. C) To improve cardiovascular function: While thiamine is important for metabolism, its primary concern in dialysis patients is neurological health. D) To prevent hyperkalemia: Thiamine does not regulate potassium levels. Dialysis- Thiamine - PD patients are routinely given thiamine supplementation - HD patients there is no general agreement - There are case reports where thiamine deficiency was implicated as the cause of Wernicke’s encephalopathy - Patients presented with confusion, chorea, acute visual loss, rapidly progressive dementia, myoclonus and convulsions - Patients received 200mg injection of thiamine followed by 100mg/day IV until they could consume foods - Neurological deficits improved in 9/10 patients (10th patient likely didn’t respond because of the delay in treatment)

Answer 23

**Correct Answer: B) Less than 4% of body weight– The optimal weight gain is less than 4% of body weight between dialysis treatments to prevent fluid overload.** A) Incorrect – While keeping weight gain low is beneficial, the standard recommendation is <4%, not <2%. C) Incorrect – 6% is considered excessive and increases the risk of complications. D) Incorrect – 8% weight gain is too high and can lead to severe fluid overload. **Hemodialysis- fluid intake & weight gain** - Between dialysis treatments it is important to monitor weight gain - It is optimal to keep weight gain <4% of body weight between dialysis treatments - Typically consuming 750-1000mL of fluid plus the amount of fluid lost through urine is recommended daily - Keeping salt low makes this easier as it reduces thirst

Answer 24

**Correct Answer: B) It helps decrease thirst and fluid retention B) Correct – Lower sodium intake reduces thirst, making it easier to manage fluid intake and avoid excessive weight gain.* A) Incorrect – Sodium restriction can help lower blood pressure, but it also has a significant effect on thirst and fluid retention, making B a better choice. C) Incorrect – Kidney stones are not the primary concern in dialysis patients, as their kidneys are already failing. D) Incorrect – Many dialysis patients produce little to no urine, so sodium restriction does not meaningfully increase urine output.

Answer 25

**Correct Answer: B) The diet is often low in vitamin K, and patients may avoid vitamin K-rich foods. B) Correct – Hemodialysis patients tend to have low vitamin K because their diet is often low in vitamin K-rich foods, and they may avoid them due to concerns about potassium or other dietary restrictions.** A) Incorrect – Dialysis does not directly remove vitamin K. C) Incorrect – Vitamin K is fat-soluble and primarily processed in the liver, not lost significantly through bile. D) Incorrect – The body's requirement for vitamin K does not increase in dialysis; rather, low dietary intake is the issue. Hemodialysis- vitamin K - Hemodialysis patients tend to have low vitamin K - They also tend to have accelerated vascular calcification - Matrix Gla protein inhibits arterial calcification and is vitamin K dependent

Answer 26

**Correct Answer: A) Vitamin E A) Correct – Vitamin E supplementation (800 IU/day for 17 months) significantly reduced cardiovascular events in hemodialysis patients.** B) Incorrect – Thiamine is important for preventing Wernicke’s encephalopathy but is not primarily associated with cardiovascular benefits. C) Incorrect – Zinc supplementation has benefits for taste, appetite, and immune function, but not cardiovascular protection. D) Incorrect – Magnesium supplementation can help with arterial calcification, but it is not primarily linked to a reduction in cardiovascular events. **Vitamin E and Hemodialysis** - Vitamin E is not generally impacted by dialysis as it excretes in bile - Vitamin E may still be helpful to mitigate oxidative stress - Supplementation with Vit E at 800IU/day in a DBPCT for 17 months significantly decreased cardiovascular incidence compared to placebo

Answer 27

**Correct Answer: C) Reduces cardiac event incidence. 600mg BID NAC reduced cardiac events by 40% in a clinical trial of hemodialysis patients.** A) Incorrect – NAC is not primarily known for reducing homocysteine; folic acid and B vitamins play that role. B) Incorrect – NAC is not directly linked to improving vascular calcification, but vitamin K is. D) Incorrect – Total mortality did not differ between NAC and placebo groups. **N-Acetyl cysteine and Hemodialysis/ NAC and Hemodialysis** - 600mg bid NAC reduced incidence of cardiac events in hemodialysis patients - Trial 134 patients for 14 months received 600mg bid NAC or placebo – primary endpoint looking at cardiac events – myocardial infarction, CV death, ischemic stoke, peripheral vascular disease with amputation or need for bypass or angioplasty surgery – 40% reduction in treatment group but totally mortality didn’t differ

Answer 28

**Correct Answer: B) Neurological symptoms and brittle nails. B) Correct – Toxicity from excess selenium can lead to brittle nails, hair loss, and neurological symptoms.** A) Incorrect – Selenium toxicity does not primarily cause liver damage. C) Incorrect – Selenium toxicity is not a known cause of hypertension. D) Incorrect – Kidney stones are not directly linked to selenium toxicity. **Selenium effects on Hemodialysis** - Selenium deficiency is common with both PD and HD as well as end stage renal failure and might contribute to impaired immune function, thyroid function and CVD - Optimal dose is currently unknown – toxicity can present with brittle nails, hair loss and neurological symptoms - 1 trial used 500mcg 3 times/week for 3 months then 200mcg 3 times a week for 3 months with no signs of overt toxicity

Answer 29

Correct Answer: A) Improves renal function A) Correct – A study found that supplementing 60mg CoQ10 TID improved renal function in hemodialysis patients. B) Incorrect – CoQ10 does not significantly affect phosphorus levels. C) Incorrect – Zinc is more closely linked to improving erythropoietin response. D) Incorrect – Carnitine, not CoQ10, has been linked to anemia improvements. **Hemodialysis- CoQ10** - 62% of the 48 patient trial showed deficient CoQ10 - May lead to peroxidative damage in hemodialysis patients - One study found supplementing 60mg COQ10 tid improved renal function in patients receiving hemodialysis

Answer 30

Correct Answer: A) Improves taste, appetite, and immune function A) Correct – Zinc supplementation improves taste acuity, appetite, pruritus, and immune function in dialysis patients. B) Incorrect – Zinc does not increase serum magnesium levels. C) Incorrect – Homocysteine levels are primarily reduced by folic acid and B vitamins, not zinc. D) Incorrect – Vitamin K is more relevant for reducing vascular calcification. **Zinc effect on Hemodialysis** - Zinc deficiency is common in hemodialysis patients - Supplementation improves – taste acuity, appetite, pruritis and erythropoietin responsiveness in dialysis patients - Can also improve immune function and for some patient’s sexual function - Optimal dosage is unclear, but some studies administered 50mg/day for 6 weeks-6months or 100mg 3 times weekly after dialysis - Ideal to assess zinc status before administration of supplementation

Answer 31

**Answer: B) Essential fatty acid (EFA) deficiency may contribute to pruritus. B is correct; EFA deficiency has been linked to pruritus in dialysis patients.** Explanation: A is incorrect because 80% of dialysis patients experience pruritus, not 50%. C is incorrect because EPO supplementation has been shown to improve pruritus. D is incorrect because fish oil supplementation has been shown to improve pruritus, not worsen it.

Answer 32

Answer: B) Folic acid supplementation has been shown to reduce homocysteine levels by 30-57%. Explanation: A is incorrect because folic acid lowers, not increases, homocysteine levels. C is incorrect because folic acid supplementation does have a significant effect on lowering homocysteine. D is incorrect because folic acid does not affect vitamin B12 levels directly. **Folic acid effect on Hemodialysis** - Majority of dialysis patients have elevated homocysteine - Supplementing with 5-10mg/day of folic acid has shown drop in homocysteine 30-57% - 1-2.5mg/day may also be effective so optimal dosing is unknown - 9 randomized trials have shown supplementing folic acid reduces risk of CVD by 10% in patients with CKD and by 15% in patients with advanced chronic kidney disease - In patients supplementing you can see serum levels 20 times higher than the range but no adverse events have been reported

Answer 33

**Answer: B) Methylcobalamin or hydroxycobalamin are recommended in ESRD patients for vitamin B12 supplementation.** Explanation: A is incorrect because cyanocobalamin can increase cyanide levels, which is harmful in ESRD patients. C is incorrect because vitamin B12 supplementation is necessary for ESRD patients. D is incorrect because vitamin B12 injections are effective in ESRD patients, especially when given in appropriate forms.

Answer 34

Answer: B) It helps improve myopathy, anemia, and cardiovascular symptoms (myopathy, anemia, and cardiovascular symptoms in dialysis patients). Explanation: A is incorrect because carnitine does not directly increase erythropoietin production. C is incorrect because carnitine supplementation does not affect homocysteine levels directly. D is incorrect because carnitine does not have a significant effect on plasma potassium levels. **Carnitine effect on Hemodialysis** - Dialysis patients have lower plasma and muscle carnitine compared to healthy controls - Lower carnitine is due to a combination of loss during dialysis and a reduction in endogenous synthesis - Carnitine deficiency contributes to myopathy, anemia, cardiomyopathy, hypertriglyceridemia, muscle cramps, asthenia common in dialysis patients **

Answer 35

Answer: A) Reduction in hospitalizations for cardiovascular diseases, because carnitine supplementation has shown to reduce hospitalizations and hospitalization frequency in dialysis patients with cardiovascular disease. Explanation: B is incorrect because carnitine has been shown to reduce hospitalizations, not increase them. C is incorrect because carnitine supplementation helps reduce erythropoietin requirements, not increase them. D is incorrect because carnitine supplementation improves symptoms like muscle cramps and fatigue, not worsens them. **Carnitine effects on CVD** - Oral dose 2g/day L-carnitine decreased arrhythmias occurring during dialysis - IV admin of 1g of carnitine after dialysis for 3 months increased mean left ventricular ejection fractions (LVEF) from 42.4% to 48.6% - Patients with low serum carnitine 20mg/kg body weight per day increases mean LVEF from 53.1% to 58.6% after 1 year - In patients with reduced LVEF 500mg/day orally improved heart related symptoms - Retrospective trial on hemodialysis patients using carnitine for 9 months had 15% reduction in hospitalizations and 36% reduced frequency of hospitalizations in patients with CVD

Answer 36

**✅ Correct Answer: B) To reduce blood pressure 👉 Why? The DASH diet is specifically designed to help lower blood pressure, which is important for kidney transplant recipients to manage hypertension and reduce the risk of graft function decline.** ❌ Wrong Answers: A) To promote weight gain: The DASH diet focuses on reducing blood pressure, not weight gain. C) To improve kidney function: While the DASH diet may help with blood pressure control, it does not directly improve kidney function. D) To enhance protein absorption: The DASH diet is not focused on protein absorption but on blood pressure regulation. Kidney Transplant - Preoperatively recommended to focus on nutrition to reduce risk of infections - Some patients may be required to undergo weight loss prior to transplant - Hypertension in kidney transplant recipients is linked to a decline in graft function and premature mortality - Diet recommendation in these cases would be a DASH (Dietary Approaches to Stop Hypertension) style diet or Mediterranean Diet

Answer 37

✅ Correct Answer: B) Grapefruit 👉 Why? Grapefruit, along with pomegranate and some herbs, can interfere with the metabolism of immunosuppressant medications, affecting drug levels and potentially causing harmful interactions. ❌ Wrong Answers: A) Fish: Fish is typically encouraged due to its omega-3 fatty acid content, which has health benefits. C) Lean meats: Lean meats are recommended for their protein content, which supports healing after transplant. D) Leafy greens: Leafy greens are generally encouraged for their nutrient density, unless specified otherwise by a doctor for specific conditions.

Answer 38

**✅ Correct Answer: C) 1.3-2.0 g/kg 👉 Why? After a kidney transplant, patients are recommended to consume 1.3-2.0 g/kg of protein for the first three months to support healing and prevent complications.** ❌ Wrong Answers: A) 0.8-1.0 g/kg: This is the recommended amount for long-term maintenance after the first 3 months post-transplant. B) 1.0-1.3 g/kg: This is below the recommended protein intake for the initial post-transplant period. D) 2.0-2.5 g/kg: This level is too high for the initial post-transplant period and could cause undue stress on the kidneys. **Post Kidney transplant – basic nutrition** - Caloric intake 25-35 kcal/kg - Protein 1.3-2.0 g/kg for the first 3 months - Then 0.8-1.0g/kg after 3 months - Soy protein recommended to also help with LDL cholesterol levels - Carbohydrates - encourage complex carbohydrates and soluble fibers - limit simple sugars - Fats – encourage omega 3 fatty acids and monounsaturated fats e.g. fish and olive oil

Answer 39

✅ Correct Answer: C) Improves renal function and decreases transplant rejection 👉 Why? Omega-3 fatty acids, particularly EPA/DHA, have been shown to improve renal function and reduce transplant rejection rates, especially in patients on cyclosporine and prednisolone. ❌ Wrong Answers: A) Reduces blood pressure: While omega-3s can help with blood pressure, the primary benefit in transplant patients is improving renal function and reducing rejection. B) Increases serum creatinine levels: Omega-3s have been shown to lower serum creatinine levels, not increase them. D) Increases weight gain: Omega-3s are not intended to cause weight gain; they support cardiovascular and renal health. **Omega 3 fatty acids - Post Transplant** - Cyclosporine can reduce renal function and increase blood pressure - Fish oil has demonstrated improvements in cyclosporine induced reduction in renal function - DBT – Patients on a combo of cyclosporine and prednisolone received 6g/day of fish oil for 1 year or placebo for 3 months - Treatment group had improved renal function (median GFR 53 ml/min versus placebo 40ml/min) - Decreased rejections 8 in fish oil group versus 20 in placebo

Answer 40

✅ Correct Answer: C) 25-35 kcal/kg 👉 Why? Post-transplant, kidney transplant patients are recommended to consume 25-35 kcal/kg to support recovery and maintain energy levels during the healing process. ❌ Wrong Answers: A) 10-15 kcal/kg: This amount is too low for post-transplant patients who need more energy to support healing. B) 20-25 kcal/kg: This is slightly under the recommended range for post-transplant recovery. D) 40-45 kcal/kg: This amount is too high and could lead to excessive weight gain, which is undesirable post-transplant.

Answer 41

**✅ Correct Answer: A) Muscle cramps 👉 Why? Carnitine supplementation (0.5-2g/day) is known to improve symptoms such as muscle cramps, fatigue, asthenia, shortness of breath especially post dialysis ** ❌ Wrong Answers: B) Reduced blood pressure: Carnitine does not have a primary role in reducing blood pressure. C) Increased appetite: Carnitine does not directly affect appetite. D) Weight loss: Carnitine is not intended for weight loss, but for improving symptoms related to muscle function and fatigue. **Carnitine Hemodialysis** - Dialysis patients have lower plasma and muscle carnitine compared to healthy controls - Lower carnitine is due to a combination of loss during dialysis and a reduction in endogenous synthesis - Carnitine deficiency contributes to myopathy, anemia, cardiomyopathy, hypertriglyceridemia, muscle cramps, asthenia common in dialysis patients

Answer 42

**✅ Correct Answer: C) Control fluid balance with sodium 1-2g/day 👉 Why? Managing fluid balance with 1-2g/day of sodium pre-transplant is important for controlling blood pressure and reducing fluid retention, which is crucial for transplant success.** ❌ Wrong Answers: A) Reduce protein intake: Protein intake is essential for supporting nutrition and healing, so it should not be reduced unless otherwise specified by a doctor. B) Increase sodium intake: Sodium should be limited to help control fluid balance, not increased. D) Avoid calcium intake: Calcium intake should be monitored, but not entirely avoided, as it is important for bone health.

Answer 43

**✅ Correct Answer: C) Control fluid balance with sodium 1-2g/day 👉 Why? Managing fluid balance with 1-2g/day of sodium pre-transplant is important for controlling blood pressure and reducing fluid retention, which is crucial for transplant success.** ❌ Wrong Answers: A) Reduce protein intake: Protein intake is essential for supporting nutrition and healing, so it should not be reduced unless otherwise specified by a doctor. B) Increase sodium intake: Sodium should be limited to help control fluid balance, not increased. D) Avoid calcium intake: Calcium intake should be monitored, but not entirely avoided, as it is important for bone health. **Pre kidney transplant Nutrition** - Protein 0.6-0.8 g/kg - Sodium – 1-2g/d – to control fluid balance - Potassium- maintain serum levels 5mEq/L, if hyperkalemic limit intake to 2g/d - Calcium –Keep daily intake below 2,000mg/d - Magnesium – Monitor serum levels provide 310- 420mg/day - Phosphorus – monitor serum levels - Vitamin D – Keep 25 hydroxyvitamin D over 30ng/mL or 75nmol/L - Multivitamin – should be renal specific

Answer 44

**✅ Correct Answer: C) 6g/day for 1 year 👉 Why? Studies have shown that 6g/day of fish oil (EPA/DHA) for 1 year improves renal function and reduces rejection rates in kidney transplant patients taking cyclosporine.** ❌ Wrong Answers: A) 1g/day: This dosage is too low to achieve the desired effects on renal function. B) 3g/day: While beneficial, 6g/day is more effective for improving renal function and reducing rejection. D) 10g/day: A dosage of 10g/day is too high and may cause side effects without additional benefit. **Post transplant – Omega 3 fatty acids** - Cyclosporine can reduce renal function and increase blood pressure - Fish oil has demonstrated improvements in cyclosporine induced reduction in renal function - DBT – Patients on a combo of cyclosporine and prednisolone received 6g/day of fish oil for 1 year or placebo for 3 months - Treatment group had improved renal function (median GFR 53 ml/min versus placebo 40ml/min) - Decreased rejections 8 in fish oil group versus 20 in placebo

Answer 45

**✅ Correct Answer: D) Minimize long-term weight gain and dyslipidemia 👉 Why? After kidney transplant, focusing on maintaining a healthy weight and lipid profile is key. This involves managing calorie intake, monitoring cholesterol, and consuming a balanced diet.** ❌ Wrong Answers: A) Minimize protein intake: Protein intake should be adequate to support healing, not minimized. B) Consume high-sugar foods: High-sugar foods should be limited to prevent weight gain and dyslipidemia. C) Limit complex carbohydrates: Complex carbs are encouraged for their fiber content, not limited. **Post transplant** - If patient is malnourished initiate enteral nutrition - Minimize long term weight gain and dyslipidemia - Maintain normal fasting blood sugar and A1C level (<7) - Monitor patient’s electrolytes – sodium and potassium - Prevent anomalies in calcium and phosphorus metabolism

Answer 46

**Grapefruit, Pomegranate, and Seville Oranges:** These fruits contain compounds that inhibit CYP3A4, an enzyme responsible for metabolizing many drugs, including cyclosporine and other immunosuppressants. Inhibiting CYP3A4 can lead to higher drug levels in the bloodstream, increasing the risk of toxicity and adverse effects. **Herbal Teas (Dandelion, Peppermint, Chamomile, Green Tea):** Dandelion can have a diuretic effect, which may interfere with fluid and electrolyte balance post-transplant. Peppermint can affect gastrointestinal motility, potentially altering the absorption of medications. Chamomile and Green Tea contain compounds that can also affect drug metabolism, particularly by affecting the CYP450 enzymes. **Herbs (St. John’s Wort, Echinacea, Feverfew, Ginseng):** St. John’s Wort accelerates the metabolism of certain drugs, potentially reducing the effectiveness of immunosuppressants. Echinacea and Feverfew can also impact immune function, which is risky for transplant patients who rely on immunosuppressants. Ginseng can interfere with blood sugar levels and also have an effect on blood pressure and platelet function, which could lead to complications. ===================================CYP3A4 and CYP450 Enzyme System CYP3A4 is a key enzyme in the CYP450 enzyme family. These enzymes are responsible for metabolizing many medications in the liver. The CYP450 system plays a crucial role in breaking down drugs so they can be eliminated from the body. CYP3A4 specifically handles the metabolism of many immunosuppressants (like cyclosporine, used in transplant patients), as well as other commonly prescribed medications. Inhibition or activation of CYP3A4 affects the drug metabolism process, leading to changes in drug concentrations in the bloodstream. Grapefruit, Pomegranate, and Seville Oranges: These fruits inhibit CYP3A4, meaning they slow down the enzyme's ability to break down certain medications. Grapefruit is particularly well-known for this interaction. It contains compounds called furanocoumarins that inhibit CYP3A4, leading to higher concentrations of the drug in the bloodstream. This can increase the risk of toxicity and adverse effects (e.g., kidney damage, higher blood pressure, etc.). Pomegranate and Seville oranges have similar compounds that inhibit CYP3A4, but not to the same extent as grapefruit. Still, they can interact with drugs like cyclosporine and cause elevated drug levels. Herbal Teas (Dandelion, Peppermint, Chamomile, Green Tea): These herbal teas can affect medication absorption and metabolism, but in different ways: Dandelion has a diuretic effect, meaning it increases urine production. This can affect the fluid and electrolyte balance in the body, which is especially important after a transplant, where maintaining balance is critical. Peppermint affects gastrointestinal motility (how food moves through the digestive tract). This could alter how well medications are absorbed because it might change the speed at which drugs pass through the stomach and intestines. Chamomile and Green Tea contain compounds that can also affect CYP450 enzymes, including CYP3A4. This can lead to changes in how the body metabolizes drugs, possibly reducing or increasing their effectiveness. Herbs (St. John’s Wort, Echinacea, Feverfew, Ginseng): St. John’s Wort: This herb accelerates the activity of CYP3A4, meaning it increases the breakdown of certain medications, including immunosuppressants like cyclosporine. This decreases the effectiveness of the drug, potentially leading to transplant rejection. Echinacea and Feverfew may affect the immune system. Since transplant patients are on immunosuppressants to prevent rejection, any interference with this immune regulation can increase the risk of rejection or infections. Ginseng can interfere with blood sugar levels (increasing or decreasing it) and can also affect blood pressure and platelet function, which may lead to complications such as bleeding or hypertension in transplant patients. Summary of What You Understood: Grapefruit, Pomegranate, Seville Oranges: Slow down the metabolism of medications (due to CYP3A4 inhibition), leading to higher drug levels and potentially toxicity. Herbal Teas: May alter drug absorption (e.g., by affecting gastrointestinal motility), making medications less effective or harder to absorb. Herbs (St. John’s Wort, Echinacea, Feverfew, Ginseng): Accelerate the breakdown of medications (St. John’s Wort speeds up CYP3A4), making them less effective, or can interfere with immune function and other physiological systems. It's crucial for transplant patients to avoid these foods and herbs, as they can interfere with the effectiveness of immunosuppressive medications, leading to increased rejection risk or toxic side effects. Always consult with a healthcare provider about dietary or herbal supplements to ensure they won't interfere with prescribed medications.

Answer 47

**✅ Correct Answer: C) 310-420 mg/day 👉 Why? Magnesium supplementation should be within this range to help maintain adequate serum levels post-transplant, which is essential for immune function and to avoid hypomagnesemia.** ❌ Wrong Answers: A) 100-200 mg/day: This is insufficient to address hypomagnesemia in post-transplant patients. B) 200-400 mg/day: While this is close, the optimal range is slightly higher. D) 500-700 mg/day: This amount could cause excessive magnesium levels and lead to toxicity.

Answer 48

**✅ Correct Answer: C) 6-12 👉 Why? Zinc deficiency is most common in the first 12 months after kidney transplant. Supplementation with 15-30 mg of zinc can help address this deficiency.** ❌ Wrong Answers: A) 1-3 months: Zinc deficiency can begin earlier but is not typically seen as most common in this period. B) 3-6 months: Zinc deficiency tends to be more prominent after 6 months post-transplant. D) 12-18 months: This period is generally when zinc deficiency resolves, not when it is most common. Post transplant – zinc - Zinc deficiency is very common in the first 12 months post-transplant and then seems to resolve - In theory zinc supplementation could interfere with anti- rejection drugs but no issues have been reported based on the literature - 15-30mg/day zinc can be used to correct deficiency best to combine with 1-2mg of copper to prevent zinc based copper deficiency

Answer 49

**✅ Correct Answer: C) Dyslipidemia 👉 Why? The majority of kidney transplant patients develop dyslipidemia (abnormal lipid levels) within a month post-transplant. A combination of diet and pharmaceutical intervention may be required.** ❌ Wrong Answers: A) Low potassium levels: Most patients are more likely to experience hyperkalemia (high potassium) post-transplant, rather than low potassium. B) Increased vitamin A intake: This is not a common concern post-transplant. D) Excessive vitamin C intake: While limiting vitamin C to under 100 mg/day is recommended, it is not the primary concern compared to dyslipidemia.

Answer 50

✅ Correct Answer: B) Supplement with folate, B6, and B12 👉 Why? Treatment with 5 mg of folic acid, 50 mg of pyridoxine (B6), and 400 µg of B12 has been shown to lower homocysteine levels and reduce the risk of cardiovascular complications. ❌ Wrong Answers: A) Increase calcium intake: While calcium might be necessary for some patients, it doesn't directly address elevated homocysteine. C) Decrease phosphorus intake: Phosphorus regulation is important, but it does not directly lower homocysteine levels. D) Administer vitamin D: While vitamin D is important for kidney health, it does not directly treat elevated homocysteine. **Homocysteine Post transplant** - Renal transplant patients have high rates of hyperhomocysteinemia - 29% of patients have low folate and 65% low pyridoxal phosphate (b6) - Treatment with 5mg/day folic acid, 50mg of pyridoxine and 400ug/day B12 helped lower homocysteine - In a DB trial the combination also reversed carotid atherosclerosis in hyperhomocysteinemic patients post kidney transplant

Answer 51

✅ Correct Answer: B) Lower LDL cholesterol levels 👉 Why? CoQ10 has been shown to improve LDL cholesterol levels and help with oxidative stress post-transplant, which can be beneficial for patients on immunosuppressants like tacrolimus. ❌ Wrong Answers: A) Increased liver enzymes: CoQ10 does not typically cause an increase in liver enzymes. C) Increased blood pressure: CoQ10 can actually help manage blood pressure, not raise it. D) Hyperkalemia: CoQ10 does not directly affect potassium levels.

Answer 52

**✅ Correct Answer: B) Low glycemic diet 👉 Why? A low glycemic diet, rich in fruits, vegetables, lean protein, and polyunsaturated fats, is recommended to manage blood sugar post-transplant and reduce the risk of diabetes.** ❌ Wrong Answers: A) High glycemic diet: A high glycemic diet can cause blood sugar spikes and is not recommended. C) High fat, low carb diet: While healthy fats are encouraged, a high-fat, low-carb diet is not ideal for blood sugar management. D) Vegetarian diet: While beneficial for some, a vegetarian diet isn't the primary focus for managing post-transplant blood sugar.

Answer 53

**✅ Correct Answer: B) Potassium levels 👉 Why? Magnesium supplementation is often associated with hypokalemia (low potassium), which requires monitoring to avoid further complications.** ❌ Wrong Answers: A) Sodium levels: While sodium needs to be monitored, it’s not directly linked to magnesium supplementation. C) Calcium levels: While calcium is important, it’s not directly impacted by magnesium supplementation in this context. D) Blood pressure: Magnesium affects cardiovascular health but is not primarily monitored for blood pressure changes in this case.

Answer 54

**✅ Correct Answer: A) St. John’s Wort 👉 Why? St. John’s Wort accelerates the metabolism of cyclosporine, reducing its effectiveness and potentially leading to transplant rejection.** ❌ Wrong Answers: B) Peppermint: While peppermint can affect gastrointestinal motility, it does not interact with cyclosporine in the same way. C) Echinacea: Echinacea may affect the immune system, but it doesn’t have the same counterproductive effect on cyclosporine. D) Chamomile: Chamomile does not have the same interaction with cyclosporine as St. John’s Wort. **Post transplant – common prescriptions and nutritional concerns** - Herbs and botanicals should only be used after discussion with physician (lots of potential interactions) - If patient on cyclosporine (immune suppressant - calcineurin inhibitor ) avoid St. John’s wort and echinacea – have counterproductive effects on the drug - Herbs/nutrients that inhibit rapamycin (immune suppressant an mTOR inhibitor)- curcumin, resveratrol, gallic acid, pomegranate, epigallocatechin and genistein **More information on immune suppressants and herbs** Cyclosporine is indeed an immunosuppressant. It is a calcineurin inhibitor that prevents T-cell activation and is used primarily in organ transplantation to prevent rejection and in autoimmune diseases. Rapamycin (Sirolimus) is an immunosuppressant as well, but it works differently than cyclosporine. It is an mTOR inhibitor, meaning it blocks the mammalian target of rapamycin (mTOR), which is crucial for T-cell activation and proliferation. It is used in organ transplantation and certain cancers. St. John’s Wort increases the metabolism of many drugs by inducing cytochrome P450 enzymes (especially CYP3A4). This means drugs are broken down faster, leading to a shorter half-life, lower drug levels in the blood, and potentially reduced effectiveness. When it says herbs inhibit rapamycin, it typically means they block its metabolism or interfere with its activity. This can have different effects: Some herbs might reduce rapamycin's effect by altering how it binds to its target. Others may prevent its activation (e.g., blocking its conversion to an active form). Some herbs might reduce clearance, leading to higher drug levels and increased risk of toxicity rather than complete inactivation and excretion.

Answer 55

✅ Correct Answer: B) Immunosuppressant medications can contribute to insulin resistance 👉 Why? Medications like corticosteroids and calcineurin inhibitors (e.g., tacrolimus, cyclosporine) can lead to insulin resistance, increasing the risk of post-transplant diabetes. ❌ Wrong Answers: A) The transplant itself does not directly cause diabetes, but medications and metabolic changes do. C) A high-protein diet does not significantly impact blood sugar regulation in this case. D) A kidney transplant does not reduce diabetes risk; in fact, it may increase it **2. If immunosuppressants impair insulin signaling and decrease insulin secretion, wouldn’t that make insulin receptors more receptive to insulin?** Not necessarily. Here’s why: Insulin resistance occurs when cells do not respond well to insulin, despite its presence. Normally, if the pancreas produces less insulin, receptors might become more sensitive to compensate. However, immunosuppressants disrupt this balance in multiple ways: Direct receptor interference – Calcineurin inhibitors (like tacrolimus and cyclosporine) interfere with insulin receptor signaling, making cells less responsive to insulin. Beta-cell toxicity – These drugs impair insulin secretion from pancreatic beta cells, but not in a way that promotes receptor sensitivity. Instead, it creates a deficiency while still promoting resistance. Glucose metabolism disruption – Immunosuppressants increase glucose production in the liver while reducing glucose uptake in muscles, further worsening insulin resistance. Corticosteroids (if used) – These increase blood sugar levels by making the liver release more glucose and decreasing cellular insulin sensitivity. So, while a natural decrease in insulin (like fasting) can increase receptor sensitivity, drug-induced impairment causes dysfunction instead, leading to insulin resistance and post-transplant diabetes.

Answer 56

**✅ Correct Answer: B) Low-glycemic diet rich in fiber, fruits, vegetables, and lean protein 👉 Why? A low-glycemic diet, similar to the Mediterranean diet, helps stabilize blood sugar levels and prevent post-transplant diabetes.** ❌ Wrong Answers: A) Refined carbohydrates lead to blood sugar spikes and should be avoided. C) While healthy fats are beneficial, an overall balanced diet is more effective for blood sugar control. D) The ketogenic diet may not be ideal for transplant patients due to its potential impact on kidney function and medication metabolism. **Post kidney transplant – blood sugar** - Diabetes is often diagnosed post transplant - Important to discuss a low glycemic diet - Low refined CHO’s, high fiber, rich in fruits and vegetables, lean protein and polyunsaturated fats - Mediterranean diet or similar low glycemic diet

Answer 57

**✅ Correct Answer: D) Chicken breast 👉 Why? Chicken breast is a good source of protein but does not provide significant calcium.** ❌ Wrong Answers: A) Almonds contain around 75mg of calcium per cup. B) Sardines (with bones) provide 325mg of calcium per 3oz. C) Chia seeds offer 179mg of calcium per 2 tbsp.

Answer 58

**✅ Correct Answer: B) Reduces proteinuria and nephrotoxicity 👉 Why? Cordyceps has been shown to improve kidney function, reduce proteinuria, and lower treatment-induced nephrotoxicity when used alongside immunosuppressants.** ❌ Wrong Answers: A) Studies have shown comparable acute rejection rates, meaning it does not increase rejection risk. C) It does not significantly suppress the immune system beyond its interaction with immunosuppressants. D) Research indicates a positive effect on kidney function. What does “immune balance” mean, and how does it reduce proteinuria and nephrotoxicity? Immune balance refers to the modulation of immune responses, preventing both excessive immune activation (which can damage tissues) and excessive suppression (which increases infection risk). **Cordyceps helps achieve immune balance by:** Regulating inflammatory cytokines – It reduces pro-inflammatory cytokines (e.g., TNF-α, IL-6) that contribute to kidney inflammation and damage. Enhancing regulatory T-cell function – This helps prevent overactive immune responses that could worsen proteinuria. Reducing oxidative stress – Less oxidative stress means less kidney cell damage, which helps preserve kidney function and reduces medication-induced nephrotoxicity. Protecting glomerular cells – Cordyceps has been shown to improve kidney filtration, which reduces protein leakage (proteinuria). Thus, by reducing inflammation and oxidative stress, Cordyceps helps protect the kidneys from both immune system damage and medication toxicity.

Answer 59

**✅ Correct Answer: B) Improves HDL cholesterol and antioxidant status 👉 Why? NAC has been shown to increase HDL cholesterol and boost antioxidant molecules, positively affecting renal function.** ❌ Wrong Answers: A) NAC helps protect the liver rather than increasing disease risk. C) NAC supports kidney function rather than suppressing it. D) NAC does not significantly impact blood sugar levels Post transplant – Liver/NAC - Liver disease is common post renal transplant because of increased risk of metabolic syndrome and due to the prescribed medications - Best to exercise regularly, low glycemic diet, avoid alcohol, sugar - NAC treatment in patients with stable renal function after transplantation increased HDL and antioxidant molecules in relation to glutathione peroxidase, with a positive influence on renal function. **NAC and Post Kidney Transplant** NAC treatment in patients with stable renal function after transplantation increased high-density lipoprotein cholesterol and antioxidant molecules in relation to glutathione peroxidase, with a positive influence on renal function.

Answer 60

**✅ Correct Answer: C) High vitamin B12 levels 👉 Why? B12 deficiency, not excess, is associated with anemia.** ❌ Wrong Answers: A) Iron deficiency is a major cause of anemia. B) EPO production decreases post-transplant, leading to lower red blood cell production. D) Inflammation increases hepcidin, which reduces iron absorption, contributing to anemia.

Answer 61

**✅ Correct Answer: B) Using capsaicin cream topically 👉 Why? Capsaicin cream can help reduce itching by desensitizing nerve endings.** ❌ Wrong Answers: A) High phosphorus levels can worsen pruritus, not treat it. C) Dehydration can worsen symptoms, so maintaining hydration is important. D) High-dose vitamin C is not recommended post-transplant due to potential kidney complications. **Post transplant – common complications Pruritis** - Common causes - Immunosuppressant medications - Build up of phosphorus - Could be other causes not specific to transplant eg scabies

Answer 62

**✅ Correct Answer: A) Nausea and confusion 👉 Why? Uremia occurs when waste products build up in the blood, leading to nausea, vomiting, confusion, and fatigue.** ❌ Wrong Answers: B) Uremia decreases appetite and energy, not increases them. C) Uremia signals worsening kidney function, not improvement. D) Uremia is caused by high urea levels, not low levels. **Uremia effects for Post Kidney transplant and Uremia** - Occurs when there is a build of waste products in the blood - Urea levels become dangerously elevated if transplant isn’t working properly - Patient symptoms include – nausea, vomiting, confusion and fatigue

Answer 63

✅ Correct Answer: A) Reduce animal protein intake 👉 Why? Lowering animal protein intake helps reduce urea production and metabolic waste buildup. ❌ Wrong Answers: B) High phosphorus intake can exacerbate kidney issues. C) A high-refined carbohydrate diet can worsen metabolic health. D) Hydration is essential to help clear waste products. **Supportive treatments for Uremia** - Foods that alkalize the urine eg carrots, bell peppers, lemon, turmeric, cinnamon - Reduce animal protein - Ensure adequate hydration

Answer 64

✅ Correct Answer: C) It speeds up drug metabolism, reducing immunosuppressant effectiveness 👉 Why? St. John’s Wort induces CYP3A4, which accelerates drug breakdown, reducing immunosuppressant levels and increasing the risk of organ rejection. ❌ Wrong Answers: A) It does not directly suppress immune function but impacts drug levels. B) It lowers, rather than increases, drug levels. D) It has a significant effect on medications.

Answer 65

**✅ Correct Answer: A) High phosphorus levels lead to calcium deposits in the skin 👉 Why? Excess phosphorus binds with calcium, leading to calcium-phosphate deposits in tissues, including the skin. These deposits activate nerve endings, causing itching (pruritus), a common issue in kidney disease and post-transplant patients.** ❌ Wrong Answers: B) Phosphorus itself does not directly irritate nerves. C) Immunosuppressants can affect phosphorus metabolism, but phosphorus itself does not cause skin dryness. D) Low phosphorus levels do not cause pruritus—high levels do.

Answer 66

**✅ Correct Answer: A) They have different metabolic and hydration needs 👉 Why? Dialysis and post-transplant patients have distinct dietary and fluid requirements. Dialysis patients may have fluid and phosphorus restrictions, while post-transplant patients need adequate hydration to maintain graft function.** ❌ Wrong Answers: B) Post-transplant patients need dialysis indefinitely – Incorrect. Successful kidney transplants eliminate the need for dialysis. C) Dialysis patients should completely avoid all sources of calcium – Incorrect. Dialysis patients may need controlled calcium intake but should not eliminate it entirely. D) Transplant patients no longer require any dietary restrictions – Incorrect. Post-transplant patients need individualized monitoring, especially for diabetes, dyslipidemia, and bone health.

Answer 67

**✅ Correct Answer: A) Erythropoietin (EPO) deficiency 👉 Why? Post-transplant, the body may produce less EPO, a hormone essential for red blood cell production, contributing to anemia.** ❌ Wrong Answers: B) Excess calcium intake – Incorrect. Calcium does not directly cause anemia. C) High vitamin D levels – Incorrect. Vitamin D supports calcium absorption but is not linked to anemia. D) Increased sodium intake – Incorrect. Sodium intake affects blood pressure, not anemia. **Post transplant – common complications Anemia** - Common causes of Anemia- - iron deficiency - Erythropoietin (EPO) deficiency- body produces less EPO after a transplant - Immunosuppression - Inflammation – elevated hepcidin can impair iron absorption **Iron-deficiency anemia is a condition **where the body lacks enough iron to produce adequate hemoglobin, the protein in red blood cells that carries oxygen. Without enough hemoglobin, tissues and organs receive less oxygen, leading to symptoms like fatigue, weakness, and pale skin. How Hepcidin Affects Iron Absorption Hepcidin is a hormone that regulates iron levels in the body. When hepcidin levels are high, it blocks iron absorption from the intestines and prevents iron release from storage sites. This can lead to iron-deficiency anemia, especially in conditions like chronic inflammation, kidney disease, or post-transplant immunosuppression. **ok so you can have normal RBC but low iron** Yes, you can have normal red blood cell (RBC) count but low iron levels, especially in the early stages of iron deficiency. This happens because: Iron stores deplete first – Before anemia develops, your body uses stored iron (ferritin) to maintain RBC production. Hemoglobin stays normal for a while – Even with low iron, RBCs can still be produced normally at first, but over time, hemoglobin production drops. Iron-deficiency anemia develops gradually – If iron levels remain low, RBCs become smaller (microcytic) and contain less hemoglobin (hypochromic), leading to anemia. So, low iron without anemia is possible and is called iron deficiency without anemia. It can still cause fatigue, weakness, and other symptoms before hemoglobin levels drop enough to be classified as anemia.

Answer 68

**✅ Correct Answer: D) Chicken 👉 Why? Chicken does not provide significant calcium, while tofu, sardines, and chia seeds are rich sources.** ❌ Wrong Answers: A) Tofu – High in calcium (861 mg per cup). B) Sardines – Rich in calcium (325 mg per 3 oz). C) Chia seeds – High in calcium (179 mg per 2 tbsp).

Answer 69

**✅ Correct Answer: A) Promote healing and prevent rejection 👉 Why? The primary goal is to support immune function, prevent rejection, and promote recovery.** ❌ Wrong Answers: B) Encourage fasting for immune reset – Incorrect. Patients need adequate nutrition post-surgery. C) Avoid all medications – Incorrect. Immunosuppressants are required to prevent rejection. D) Only eat liquid foods – Incorrect. Solid food should be introduced within 24 hours if tolerated.

Answer 70

**✅ Correct Answer: A) Vitamin D 👉 Why? Vitamin D plays a key role in calcium absorption and bone health, helping prevent osteopenia and osteoporosis.** ❌ Wrong Answers: B) Vitamin C – Incorrect. Needed for immune function but not a key player in bone health. C) Vitamin K – Incorrect. Supports bone metabolism, but Vitamin D is more critical for calcium absorption. D) Vitamin B12 – Incorrect. Essential for nerve function and red blood cell production, but not directly related to bone loss.

Answer 71

✅ Correct Answer: A) It maintains allograft function 👉 Why? Proper hydration is crucial to prevent kidney damage and rejection. ❌ Wrong Answers: B) It prevents high blood pressure – Partially correct but not the main reason for hydration. C) It eliminates the need for immunosuppressants – Incorrect. Immunosuppressants are always required. D) It prevents diabetes – Incorrect. Hydration supports kidney function but does not directly prevent diabetes.

Nutrition for Kidney Health 3rd Year 2nd Semester Flashcards

(95 cards)