CSR Pediatric Renal Nutrition 2

Question 1

Recombinant human growth hormone (rhGH) therapy is sometimes used in children with CKD-related growth failure. Which nutritional PREREQUISITE must be met before initiating rhGH to ensure optimal response?

Accepted Answer

Adequate nutritional status must be optimized (meeting calorie and protein targets, correcting metabolic acidosis, normalizing CKD-MBD) — as rhGH is ineffective in the presence of severe malnutrition or uncontrolled metabolic derangements

Answer

rhGH requires adequate substrate (energy, protein) to promote protein anabolism and bone formation. Metabolic acidosis blunts the GH-IGF1 axis response, and CKD-MBD impairs bone growth response to rhGH. These must be optimized for rhGH to be effective.

Question 2

What is the recommended dietary phosphorus intake for a 6-year-old child with CKD Stage 4, compared to the DRI for a healthy 6-year-old?

Accepted Answer

Restricted to 80% of DRI: approximately 800–1000 mg/day, to control hyperphosphatemia while ensuring adequate growth and bone mineralization

Answer

KDOQI pediatric guidelines recommend restricting phosphorus to approximately 80% of DRI (approximately 800–1000 mg/day for a 6-year-old) to control hyperphosphatemia while ensuring adequate phosphorus for bone mineralization and growth — avoiding both excess and deficiency.

Question 3

A 15-year-old adolescent on hemodialysis presents with poor dietary adherence. Which counseling strategy is MOST appropriate given adolescent developmental psychology?

Accepted Answer

Use a shared decision-making approach with the adolescent as the primary partner, acknowledge their developmental need for autonomy, identify peer-related dietary challenges (school lunch, social eating), and set collaborative realistic goals

Answer

Adolescents are in a developmental stage where autonomy, peer relationships, and identity formation are paramount. Excluding them from their own care alienates them and worsens adherence. Shared decision-making that respects their growing autonomy while providing education and support produces the best adherence outcomes.

Question 4

In a premature infant (32 weeks gestation) with congenital renal anomalies requiring early dialysis, which feeding consideration is HIGHEST priority?

Accepted Answer

Providing human breast milk (or preterm formula) as the primary nutrition source — optimized with human milk fortifier if needed — via gavage feeding, supporting brain development, immune function, and gut maturation

Answer

Human breast milk is the gold standard for premature infants. It provides optimal protein, immune factors, growth factors, and neurotrophic factors for brain development. In premature CKD infants requiring dialysis, breast milk via gavage with fortification (for extra calories/protein) is the highest priority feeding strategy.

Question 5

Iron deficiency is common in pediatric CKD patients on erythropoiesis-stimulating agents (ESAs). What is the preferred route of iron supplementation in a child on hemodialysis?

Accepted Answer

Intravenous iron sucrose or ferric gluconate administered during hemodialysis sessions, as oral iron has poor absorption and GI side effects in dialysis patients

Answer

IV iron (iron sucrose, ferric gluconate) administered during HD sessions provides reliable, predictable iron delivery without GI side effects. Oral iron absorption is impaired by uremia, inflammation, phosphate binders (calcium and non-calcium binders reduce iron absorption), and GI side effects limit adherence in children.

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

CSR Pediatric Renal Nutrition 2