Children with normal kidney function have great latitude in day-to-day nutritional intake, but those who have kidney disease often require significant nutritional guidance to support their nutrient needs. Nutritional management of infants and children with kidney disease requires an understanding not only of the primary renal disease but also an evaluation of the family dynamics surrounding daily eating patterns. Nutritional management of such children is best accomplished as a collaborative effort of a skilled pediatric kidney dietitian and other members of the pediatric kidney team.
The dietary prescription for children with chronic kidney disease (CKD) varies according to the glomerular filtration rate (GFR) (see Table 36.1).1 In addition, the nutritional requirements in diseases that affect tubular nutrient resorption independent of glomerular filtration differ significantly from those children with chronic reductions in GFR. As a result, there is no single universal dietary prescription for all children with kidney disease. Instead, nutrition must be tailored to the underlying disease, the degree of kidney dysfunction, and the underlying glomerular and tubular physiology.
Table 36.1. Staging of Chronic Kidney Disease
| Stage | GFR (mL/min/1.73 m2) | Description |
|---|---|---|
| CKD 1 (T if with transplant) | ≥90 | Kidney damage with normal or increased GFR |
| CKD 2 (T if with transplant) | 60-89 | Mild decrease in GFR |
| CKD 3 (T if with transplant) | 30-59 | Moderate decrease in GFR |
| CKD 4 (T if with transplant) | 15-29 | Severe decrease in GFR |
| CKD 5 (D if on dialysis,a T if with transplant) | <15 (or dialysis) | Kidney failure |
Abbreviations: CKD, chronic kidney disease; GFR, glomerular filtration rate.
a Hemodialysis or peritoneal dialysis.
Adapted from Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005: 67(6);2089-2100.
The effects of neurodevelopmental impairments, which are common in this population, may affect oral motor skills, while uremia-induced anorexia may compromise oral intake. Providing appropriate and adequate nutrition is often a very challenging aspect of CKD management.
This chapter reviews nutritional considerations for pediatric patients with the following kidney-related diseases: nephrolithiasis, hypertension, nephrotic syndrome, acute glomerulonephritis (GN), tubular disorders, acute kidney injury (AKI) including renal replacement therapy, and chronic kidney disease (including end-stage kidney disease, dialysis, and kidney transplant patients). As much as possible, nutritional recommendations are presented relative to nutritional standards (dietary reference intakes [DRIs]) established by the National Academy of Medicine.