Pediatric Renal Nutrition Flashcards

Growth hormone resistance in children with CKD is mediated by which mechanism most directly linking uremia to impaired linear growth?

Answer: Uremia-related downregulation of hepatic GH receptor and postreceptor signaling defects (reduced Janus kinase 2/STAT5 activation), leading to low IGF-1 production despite normal or elevated GH levels

CKD causes uremic resistance to GH by downregulating hepatic GH receptors and impairing intracellular GH signaling (JAK2/STAT5 pathway), resulting in low IGF-1 levels despite elevated serum GH. This is the molecular basis for growth failure in pediatric CKD.

A 7-year-old child with CKD Stage 5 on CAPD is being prepared for school. Which specific dietary challenge unique to the school setting should the dietitian address?

Answer: Develop a personalized school meal plan addressing fluid/electrolyte restrictions, provide education to school staff about dietary needs, and enable the child to participate in school meals with appropriate modifications

Children with ESRD on dialysis face unique school challenges: restricted school lunch menus, social eating pressure, and teachers/staff unaware of dietary needs. A school meal plan with staff education, modified school lunch options, and age-appropriate patient education helps the child manage restrictions while participating normally in school.

In pediatric CKD, which formula or milk modification is MOST appropriate for an infant (4 months old) requiring caloric concentration due to fluid restriction on peritoneal dialysis?

Answer: Concentration of standard infant formula or breast milk to 24–30 kcal/oz using glucose polymer and/or medium-chain triglyceride oil additions, while monitoring electrolytes closely

Caloric concentration of breast milk or standard infant formula using glucose polymers (Polycose) and/or MCT oil achieves higher caloric density (24–30 kcal/oz) within the restricted fluid volume, without using adult renal formulas that are nutritionally inappropriate for infants.

Which gastrointestinal complication is MOST common in infants on peritoneal dialysis and directly impacts feeding tolerance and nutritional status?

Answer: Gastroesophageal reflux (GERD) and delayed gastric emptying exacerbated by increased intra-abdominal pressure from PD fluid, causing vomiting and feeding intolerance

Peritoneal dialysis fluid fills the abdominal cavity, increasing intra-abdominal pressure. In infants (who have a large abdomen-to-body ratio), this exacerbates GERD and delays gastric emptying, causing frequent vomiting and poor feeding tolerance — a major contributor to growth failure.

When transitioning a pediatric CKD patient from dialysis to a kidney transplant, which nutritional counseling topic is MOST critical in the FIRST clinic visit post-transplant?

Answer: Food safety for the newly immunocompromised patient: avoid undercooked meats, raw eggs, unpasteurized dairy and juices, and raw sprouts — while liberalizing previous electrolyte restrictions

Post-transplant immunosuppression makes foodborne pathogens life-threatening. The FIRST priority is food safety education — the transition FROM dialysis restrictions AND the new risks of immunosuppression. Previous electrolyte restrictions (often strict on dialysis) are typically liberalized as the new kidney improves excretory function.

A 12-year-old child with ESRD on dialysis has a serum phosphorus of 8.5 mg/dL despite taking prescribed calcium carbonate binders. A dietary review reveals adequate phosphorus restriction. What is the MOST appropriate next clinical action?

Answer: Switch to a non-calcium phosphate binder (sevelamer or lanthanum), as calcium carbonate may be inadequate for this level of hyperphosphatemia and adds excessive calcium load — particularly concerning in growing children

Persistent severe hyperphosphatemia (8.5 mg/dL) despite dietary restriction and calcium carbonate indicates need to switch to a more potent non-calcium binder. Calcium carbonate provides limited phosphate binding in pediatric doses and its excessive calcium delivery risks vascular and soft-tissue calcification.