Nephropathy: feeding the child with kidney disease

By Cristiano Antonino On May 25, 2023

Kidney disease and nutrition: parents of children with kidney disease must pay particular attention to correct and specific nutrition

It is essential that parents of children with nephropathy understand the importance of excluding sodium from the diet

Nephrotic syndrome is a disease characterized by accumulation of fluid in the tissues (oedema), a large loss of protein in the urine (proteinuria), hypoalbuminemia (low levels of albumin in the blood) and high amounts of fat in the blood (hyperlipidemia). .

The diet to follow is essentially a balanced diet, normal amount of protein, with little salt (low sodium) and low fat (low fat), although diets can vary from person to person and can even change during illness.

A consequence of therapy with cortisone drugs is the increase in appetite, therefore the diet will have to be particularly attentive to the introduction of foods with a high calorie content.

Nephropathy, the most “urgent” aspect of nutrition to pass on to parents is the elimination of sodium

The degree of swelling of the nephrotic child is in fact proportional to the amount of sodium that the child accumulates.

Sodium is a component of table salt and bouillon cubes.

A low sodium diet involves eliminating salt from foods and limiting sodium-rich foods such as:

Cow milk;
Common bread;
Dairy products-cheese;
All sausages;
Preserved foods in general;
soda drinks.

Acute renal failure is characterized by a rapid reduction of the normal function of the kidneys accompanied by alterations resulting from the accumulation in the body of products that are formed after the intake of proteins and which cannot be eliminated.

Dietary treatment is usually an emergency treatment and involves a high-calorie prescription with fluid, electrolyte, and protein restriction:

Calories: recommended requirement by age;
Proteins: recommended requirement by age; those of animal origin are preferable. Possible protein restriction in special cases.

Particularly important is the regulation of the amount of water and electrolytes.

Excess water and potassium can be life threatening for the child with acute kidney failure.

Therefore, an initial restriction of water, sodium, potassium and phosphorus intake is usually expected in these patients.

Vegetable oils, butter, margarine, lard, tomato paste, jams and most fruits and vegetables have a zero or very low phosphorus content.

All protein foods have a high phosphorus content, therefore the daily protein intake must respect the prescribed amount in order not to increase the phosphorus intake.

Nephropathy, permitted foods:

Lamb, duck, beef, rabbit, chicken, veal, herring, squid, grouper, sticks, tuna, cod, sea bream, octopus, cuttlefish, sole, trout, egg white, fresh vegetables, canned vegetables, dried vegetables (if boiled in plenty of water).

Nephropathy, prohibited foods:

Horse, pork, turkey, shellfish, prawns, salmon, egg yolk, cheese, cocoa and chocolate, dried fruit. In any case, certain preserved foods that contain phosphorus as a “preservative” substance should be excluded.

Potassium is present in more or less important quantities in almost all foods.

Therefore, the following should be kept in mind:

Legumes and especially potatoes are rich in potassium and should be boiled in plenty of water;
Allowed: black cherries, pineapples, prickly pears, strawberries, persimmons, tangerines, apples, blueberries, pears, grapes, canned fruit and plums;
Prohibited: apricots, pineapples, bananas, cherries, coconut, watermelon, figs, kiwis, pomegranates, melons, currants;
Bread, pasta, flour, rice and polenta contain little potassium, wholemeal bread and pasta are to be used in moderation;
All oils, fats, butter, margarine can be used freely as well as honey, sugar and jam, fruit jellies, soft drinks.

Chronic renal failure is a condition characterized by the progressive and irreversible reduction of renal function.

Chronic renal failure not on dialysis treatment

The dietary principles are:

Adequate calorie intake;
Regulation of protein intake;
Stabilization of electrolyte values (sodium and potassium);
Regulation of calcium and phosphorus intakes;
Regulation of water supply;
Vitamin supplementation.

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Chronic renal insufficiency in dialysis treatment

The child reaches dialysis replacement treatment when the creatinine clearance drops below 15 ml/min/1.73 sq m.

The dietary indications in hemodialysis are as follows:

Normo-hypercaloric;
Proteins: normo-hyperprotein (depending on the dialysis, peritoneal or hemodialysis treatment);
Electrolytes: according to pre-dialysis blood values;
Water: it is established on the basis of the balance between income and expenditure.

It represents the last expected goal for the child after the phase of the replacement treatment.

If with the transplant we see a restoration of renal function, it is still necessary to follow some dietary rules in relation to cortisone therapy.

Therefore the initial recommendation will be that of a free and balanced diet in terms of nutrients but particularly attentive to caloric intake, especially in children with a marked increase in appetite, and to sodium intake if hypertension is present.

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