Diet plays a very important part in the management of chronic renal failure and the dietician will discuss this with you. The family may be asked on occasions to keep a diary of the child's intake over three days in order that the diet can be assessed.
All children need a well balanced diet consisting of energy containing foods, proteins, vitamins and minerals in order to grow and develop into adults. Children with chronic renal failure have special requirements and need individual assessment. In general, energy intake may have to be increased and protein controlled.
Children require protein for growth and repair. Urea is a waste product of protein digestion and is filtered out of the body by the kidneys into the urine. As the kidney function gets worse, urea and other wastes build up in the blood and make the child unwell.
Before dialysis, a reduction in the amount of protein in the diet is often advised to help reduce the amount of urea produced by the body. However, it is important that the dietician looks at each individual child’s diet to see that there is adequate protein for growth. Once dialysis has started the amount of protein required will depend upon the type of dialysis chosen.
There is usually no restriction on protein intake after a successful transplant.
Energy is provided in the diet from carbohydrates (sugars and starches) and fats. It is very important that enough energy giving foods are included in the diet. Energy supplements may be necessary when intake is poor.
The kidneys control the amount of salt (sodium) the body needs and any excess if passed into the urine. When the kidneys are not working well sodium levels may build up in the body and cause thirst, puffiness (oedema) and possibly high blood pressure (hypertension). To prevent this you may be asked to reduce your child’s intake of salt. You can do this by not adding salt to food at the dining table and avoiding highly salted foods such as crisps and salted snacks.
There are some children who actually lose sodium in their urine. If this is the case then there will be no salt restriction and sodium supplements may be necessary.
Poor kidney function may cause an increase in the level of potassium in the blood. This can be dangerous as it can be harmful to the heart. It is important that foods high in potassium are avoided. The dietician’s advice will depend upon each individual child’s level of kidney function and other treatment.
Calcium and phosphate are both important for the growth of strong bones.
In chronic renal failure there is a build up of phosphate in the blood because the kidneys cannot excrete enough phosphate in the urine. There is also a lack of a very special form of vitamin D made by the kidneys. This can lead to a type of bone disease known as renal osteodystrophy. However, this problem may be prevented with dietary advice and medications.
The kidneys control fluid balance within the body. When the kidneys cannot get rid of excess water, fluid is held within the tissues causing weight gain, puffiness (oedema) and a rise in blood pressure (hypertension). If this happens it may be necessary to reduce the amount of fluid that your child drinks. Salty foods should also be reduced to avoid increasing thirst.
With some types of kidney disease, the kidneys produce large amounts of weak urine. In this case it may be necessary to encourage lots of fluid.
Vitamins and minerals are essential for good health. A good balanced diet should provide adequate amounts.
Children with chronic renal failure may have poor appetites and therefore may need a daily vitamin and sometimes mineral supplement. Some vitamins are lost during dialysis and these will also need to be replaced by a prescribed supplement.
NKF Controlled Document No. 168, Your Child & Chronic Renal Failure — An introductory manual for families — Is there a special diet?, written 12 June 2004.
Content compiled by members of the Children’s Renal & Urology Unit, QMC, Nottingham.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
Page created: 12 June 2004
Last updated: 15 August 2007
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