[Nutrition of pediatric patients with chronic renal failure]

Adequate nutrition plays a key role in the conservative management of chronic renal failure. Recent experience favours initiation of dietary measures at an earlier stage of renal failure (RF) than hitherto advocated. The requirements of protein and energy are preferably calculated according to height rather than age. Protein intake is often far in excess of the recommended (minimum) intake of 0.25 g per cm body height (taken as 100%). With the aim to keep serum urea concentration close to normal, intake in mild RF (GFR 33-50 ml/min per 1.73 m2) is restricted to 150%, in moderate RF (15-33 ml/min) to 120%, and in severe RF (less than 15 ml/min) to the minimum. High quality protein (greater than 70% of animal origin) is advocated in case of severe restriction. Further limitations are possible with administration of essential amino acids and keto analogues. Energy requirements vary with height (56-75 kJ per cm body height). Many patients require a supplementation, e.g. oligosaccharides. Intestinal phosphate absorption (and renal excretion) is adjusted according to the degree of RF by reduction of intake and administration of phosphate binders (aluminium hydroxide or calcium carbonate). Vitamin D is now often given as one of its polar metabolites. Severe dietary restrictions require a high motivation of the patient, family and staff and are only successful when a good state of health can be maintained.