The role of nutrition in the care of children with renal insufficiency

In this article, the nutritional problems associated with chronic renal insufficiency are identified and tentative approaches suggested. Success in dealing with these problems can be determined only over the course of months and years and require regular assessment of several standard nutritional markers. Standards are available for height, weight, mid-arm circumference, and skinfold thickness, along with detailed instructions for performing these tests. Height should be measured at least twice a year and weight at each clinic visit. Measurements of skinfold thickness and mid-arm circumference should be performed monthly. Standards for American children are available. Radiographs of the left hand-wrist and left knee should be obtained twice yearly for assessment of skeletal maturity and renal osteodystrophy. An analysis of dietary intake should be performed monthly through the use of three-day diet histories. Plasma levels of glucose, triglycerides, cholesterol, albumin, and transferrin should be monitored on a regular basis. If essential amino acid or ketoacid supplements are prescribed, determination of plasma amino acid patterns is also necessary. Much remains to be learned about the costs and benefits of nutritional therapy in children with chronic renal insufficiency and special attention needs to be addressed to the first two years of life, when growth is normally most rapid. The appropriate points at which to introduce diet modification or begin dialysis need to be determined while greater efforts are devoted to the creation of more appealing special foods and more varied diet plans.