Diététique et néphropathies de l'enfant

Dietary recommendations constitute a major intervention in children with renal diseases. A sodium-limited diet is prescribed in potential or overt sodium retention states, such as nephritic syndromes and, generally speaking, in glomerulo-nephritis. Practical modalities of this prescription are explained taking into account the sodium content of the different foods. Diet plays a major role in the treatment of the infant with renal failure, because related anorexia and gastrointestinal disorders frequently result in naso-gastric or gastrostomy nutrition in order to provide sufficient energy. The principles of diet in patients with chronic renal impairment have evolved these last years. The previously recommended severe protein restriction is no longer recommended. Nevertheless, according to age and degree of renal impairment, recommendations for protein intakes are proposed on the basis of standard occidental alimentary habits, generally largely above the minimum amounts as estimated by experts taking into account the age. Limited protein intakes is useful for limiting phosphorus and acid loads, but its interest in slowing the renal function degradation remains questionable. Other recommendations concern the child with renal failure, especially potassium limitation when GFR decreases to below 20 mL/mn; water and sodium intakes must also be adjusted. Examples of dietary regimens together with practical indications are provided. Diet in nephrogenic diabetes insipidus and in some metabolic lithiasis is also considered.