Role of dietary energy supplementation in growth of children with chronic renal insufficiency.

Abstract

SummaryThe effect of dietary energy supplements in children with varying degrees of chronic renal insufficiency was investigated. Despite an increased energy intake of 8-4oO there was no increase growth velocity, although some patients reported improved wellbeing and activity. The proportion of dietary energy supplied by protein fell significantly during supplementation. The evidence suggests that the reduced energy intake of children with chronic renal insufficiency is a related but not causal factor in their growth retardation.

Growth of the Kidney following Unilateral Antireflux Surgery

“…Urinary Infection. It is well known that acute and chronic infection may cause an arrest of linear growth but in the absence of renal failure this is most likely to be due to a deficient calorie intake [14,21,22], The results of our own observations suggest freedom of infection was an important factor ( fig. 2b) as the growth velocity rate was reduced in 13 patients who had been infection free for 2 years prior to surgery.…”

Orexigenic and anorexigenic mechanisms in the control of nutrition in chronic kidney disease

“…However, when energy intake exceeds 75% of recommended allowance, further growth improvement does not occur [13]. Despite the general use of supplemental feedings in children with CKD, it is not well established whether these supplements consistently improve height or weight gain [14]. Body composition studies suggest that these children gain fat mass instead of lean body mass [15,16,17].…”

Growth Retardation in Children with Chronic Renal Insufficiency

“…Acidosis interferes with growth hormone (GH ) secretion [16], Anorexia resulting in suboptimal nutrition and inade quate caloric intake is a frequent clinical consequence o f C R I [11]. Caloric intake approaching 100% o f the recom mended daily allowance for age has been associated with improvement in growth velocity [17], Infants with C R I are particularly vulnerable to the adverse affects o f inade quate caloric intake on growth: therefore, supplemental nasogastric tube feeding has been proposed to ensure opti mal caloric intake [18], The initial response to such an approach in infants is at times rewarding; however, sus tained improvement in growth velocity is not uniform as C R I progresses [19],…”