Growth during treatment with low-protein diet in children with renal failure

Fourteen children, 10 boys and 4 girls, with chronic progressive renal failure were treated with a low-protein (0.4-2 g/kg body wt and maximum 20 g/day), high-energy diet (55-130 kcal/kg body wt) and supplemented with essential amino acids and histidine (0.21-0.5 g/kg body wt). The mean age at the onset of treatment was 9.9 years (5.5 months - 15.3 years), mean serum creatinine 461 mumoles/1 (167-1110) and mean BUN 60.2 mmoles/1 (20-83). Indications for treatment were incipient or manifest growth retardation. A 50% reduction of BUN was found after about 2 weeks of treatment while serum creatinine remained unchanged. BUN remained decreased during therapy despite further increase of serum creatinine. The mean duration of treatment was 21 months (range 4-48). Increasing appetite and vitality were found after introduction of the diet, which was well accepted by most of the children while their general condition remained satisfactory. The earlier decrease of growth rate was interrupted and a linear or almost linear growth within the SD-scores at onset of treatment was seen in 10 of the 14 children. Three children had a reduced growth rate and one child did not grow at all during treatment. Signs of osteodystrophy did not improve during the diet. It is speculated that the protein restriction has a detoxifying effect, which together with supplementation of amino acids and a high energy supply could in part correct the metabolic disturbances and provide an opportunity for anabolism and growth.(ABSTRACT TRUNCATED AT 250 WORDS)