Renal Transplant Flashcards
Why do we suspect kidney disease is on the rise?
As the etiologies leading to CKD, such as diabetes and hypertension are also on the rise
Patients who get a kidney transplant before dialysis live an average of ____ years longer than if they stayed on dialysis
10-15 years
What is the nutritional pre-transplantation goal?
To optimize nutritional status to decrease:
- Surgical risk
- Post surgical complications
- Length of hospital stay
Both ____ and ______ nutrition can increase risk of post-surgical complications
Under and over
In over nutrition, obese patients have what disadvantaged?
- Higher mortality rate
- Lower graft function
- Incr. incidence of wound complications
- More frequent ICU admissions
- More frequent intubations
- Increased incidence of post-transplant diabetes
In the acute post-transplant phase, what is the nutritional priority?
- To manage the increased metabolic demands of surgery
- And to address unwanted side effects of immunosuppressive drugs (Which patients will be on for life)
The immunosuppressive drug, cyclosporin, has what undesirable side-effects?
- Gingival hyperplasia
- GI disturbances
- HyperG
- Gynecomastia
- Hepatotoxicity
- Nephrotoxicity
Which side effect of immunosuppresive drugs will decrease glycogen synthesis?
Hepatoxicity
What is used to inhibit the production of lymphokines?
Corticosteroids
Side effects of corticosteroids?
- Impaired wound healing
- Avascular necrosis of long bones
- Upper GI ulceration
- Protein catabolism
- Hypertension
- Steroid induced diabetes
- Stimulation of appetite, weight gain
What are the typical post-transplant protein and energy needs?
Will increase for up to 6-8 weeks post-op dye to stress and excessive doses of corticosteroids
Discuss CHO implications in the post-transplant patient
-Often glucose intolerance and insulin resistance secondary to hyperglycemia by corticosteroids and immunosuppressive drugs
How can we adjust CHOs to minimize the risk of developing steroid-induced diabetes?
Emphasize on complex carbohydrates, dietary fibres etc
Fat in post-transplant patients?
25-25% of total energy
- Max SFA of 7%
- Remaining are MUFA and PUFA
Should sodium be restricted in renal transplants?
Yes, as HTN is common
What is the implication of potassium and transplants?
Hyperkalemia can be induce by poor graft function, impaired potassium excretion and potassium-sparing diuretics
When should potassium be spared?
In the acute period and chronic period if hyperkalemia
what should be avoided if taking immunosuppressive drugs tacrolimus and cyclosporine?
Avoid grapefruit and grapefruit juice
When is the acute phase?
Up to 8 weeks post-transplant and during acute rejection
When is the chronic phase?
After 8 weeks
Acute phase protein?
1.3-2.0 g/kg/day
Chronic phase protein?
0.8-1.0 g/kg/day with functioning transplant
Acute phase kcals?
30-35 kcal/kg
Chronic phase kcals?
25-35 kcal/kg to maintain desirable weight
