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      Crecimiento y estado nutricional en niños con enfermedad renal crónica

      case-report

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          Abstract

          La enfermedad renal crónica (ERC) es un síndrome clínico que resulta del deterioro progresivo de la función renal, afectando el crecimiento y estado nutricional en niños. El objetivo del presente trabajo fue evaluar estas variables en niños con diferentes estadios de ERC. Métodos: se realizó un estudio descriptivo y transversal entre noviembre 2010 y marzo 2011, en 17 niños entre 2 y 12 años (13 varones, 4 niñas). Se consideraron variables e indicadores antropométricos: peso, talla, circunferencia media de brazo (CMB), pliegue tríceps (PTr), áreas grasa (AG) y muscular (AM) e Índice de Masa Corporal (IMC), parámetros bioquímicos (proteínas totales, albúmina, calcio, potasio) e ingesta dietética (recordatorio de 24 horas, porcentaje de adecuación). Las variables e indicadores antropométricos fueron evaluados según el Estudio Nacional de Crecimiento y Desarrollo Humanos; la adecuación dietética según los Valores de Referencia de Energía y Nutrientes para la Población Venezolana. Resultados: El 47,1% y 52,9% presentaron déficit de crecimiento en peso y talla respectivamente, 82,4% presentó CMB normal; déficit de PTr, AG y AM (76,5%). En CMB, PTr, AG y AM, la categoría bajo aumentó con el estadio, siendo el 4 el más afectado. Las proteínas totales fueron normales en el 100%, albúmina: 76,5% y calcio en 70,6%; potasio estuvo bajo en el 47,1%. La ingesta calórica fue deficiente en el 58,8% y adecuación proteica baja en el 41,2%, sin relación con el estado nutricional. Conclusiones: El diagnóstico temprano de la ERC permitirá una intervención precoz, ayudando a minimizar el impacto sobre el estado nutricional.

          Translated abstract

          Chronic renal disease (CRD) is a complex syndrome resulting from a progressive deterioration of kidney function, which affects growth and nutritional status in children. The objective of this study was to evaluate these variables in children with different stages of CRD. Methods: a descriptive study was performed between November-2010 and March-2011, in 17 patients ages 2 to 13 years (13 males, 4 females). Anthropometric variables and indicators were considered, such as body weight (W), height (H), mid arm circumference (MAC), triceps skinfold (TSK), fat and lean mass (FM, LM), and body mass index (BMI); biochemical parameters (total serum proteins, albumin, calcium, potassium) were measured and dietary intake was assessed by 24-hour recall and nutritional adequacy. Anthropometric variables and indicators were evaluated according to the National Study of Human Growth and Development; and dietary intake according to the Energy and Nutrient Reference Values for Venezuelan Population. Results: growth deficit was present in 47.1% and 52.9%, for weight and height respectively; 82.4% had normal MAC and 76.5% had normal TSK, LM and FM. In regard to MAC, TSK, FM and LM, deficits cases increased with the stage of CRD, with stage 4 being the most affected. Total serum proteins were normal in 100%, serum albumin in 76.5% and calcium in 70.6%; potassium was low in 47.1%. Dietary intake was deficient in 58.8% of patients and protein adequacy was low in 41.2%, with no relation to the nutritional status. Conclusions: early diagnosis of CRD will allow an early intervention, contributing to minimize the impact on the nutritional status.

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          Nutrition in children with CRF and on dialysis

          The objectives of this study are: (1) to understand the importance of nutrition in normal growth; (2) to review the methods of assessing nutritional status; (3) to review the dietary requirements of normal children throughout childhood, including protein, energy, vitamins and minerals; (4) to review recommendations for the nutritional requirements of children with chronic renal failure (CRF) and on dialysis; (5) to review reports of spontaneous nutritional intake in children with CRF and on dialysis; (6) to review the epidemiology of nutritional disturbances in renal disease, including height, weight and body composition; (7) to review the pathological mechanisms underlying poor appetite, abnormal metabolic rate and endocrine disturbances in renal disease; (8) to review the evidence for the benefit of dietetic input, dietary supplementation, nasogastric and gastrostomy feeds and intradialytic nutrition; (9) to review the effect of dialysis adequacy on nutrition; (10) to review the effect of nutrition on outcome.
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            Measuring nutritional status in children with chronic kidney disease.

            Children with chronic kidney disease (CKD) are at risk of protein-energy malnutrition. Existing clinical practice guidelines recognize this and recommend specific methods to assess nutritional status in patients with CKD. This review summarizes the methods for nutritional assessment currently recommended in the United States for children with CKD and details the strengths and limitations of these techniques in the clinical setting. Dietary assessment, serum albumin, height, estimated dry weight, weight/height index, upper arm anthropometry, head circumference, and the protein equivalent of nitrogen appearance are reviewed. We also describe methods for body-composition assessment, such as dual-energy X-ray absorptiometry, bioelectrical impedance analysis (BIA), total body potassium, densitometry, and in vivo neutron activation analysis, pointing out some advantages and disadvantages of each. In CKD, fluid overload is the most important factor leading to misinterpretation of nutritional assessment measures. Abnormalities in the distribution of fat and lean tissue may also compromise the interpretation of some anthropometric measures. In addition, metabolic abnormalities may influence the results obtained by some techniques. Issues specific to evaluating nutritional status in the pediatric population are also discussed, including normalization of nutritional measures to body size and sexual maturity. We stress the importance of expressing body-composition measures relative to height in a population in whom short stature is highly prevalent.
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              Nutrition and growth in relation to severity of renal disease in children.

              Practical joint medical/dietetic guidelines are required for children with chronic renal insufficiency (CRI). Nutritional status and growth were compared in 95 children (59 male) > 2 years age with CRI, grouped following [51Cr]-labelled EDTA glomerular filtration rate (GFR, ml/min/1.73 m2) estimations into 'normal' kidney function [GFR > 75 (mean 104 (SD 18.9), n = 35], mild (GFR 51-75, n = 23), moderate (GFR 25-50, n = 19) and severe CRI (GFR < 25, n = 18). Anthropometry [weight (wt.), height (ht.), and body mass index (BMI)], laboratory investigations and a 3-day dietary record were obtained. All anthropometric indices deteriorated with worsening renal function, from mean SD scores for wt., ht. and BMI in 'normal' children of 0.32 (SD 1.2), 0.4 (SD 1.0) and 0.1 (SD 1.3), respectively, to values of -1.28 (SD 1.1; P < 0.001), -1.52 (SD 1.1; P < 0.001) and -0.42 (SD 1.1; NS) in severe CRI. Mean total energy intake decreased from 103% (SD 17) estimated average requirement (EAR) in 'normal' children to 85% EAR (SD 27; P = 0.004) in severe CRI. Mean serum PTH concentrations (normal laboratory range 12-72 ng/l) were higher in moderate [67 ng/l (SD 58), P < 0.001] and severe CRI [164 ng/l (SD 164), P < 0.001] and mean serum phosphate concentrations were higher in severe CRI (1.54 mmol/l (SD 0.17), P = 0.009) compared to 'normal'. Disturbances in nutritional intakes, bone biochemistry and growth occur early in CRI and suggest the need for joint medical/dietetic intervention in children with mild and moderate CRI, in addition to those with more severe CRI.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                avpp
                Archivos Venezolanos de Puericultura y Pediatría
                Arch Venez Puer Ped
                Sociedad Venezolana de Puericultura y Pediatría (Caracas )
                0004-0649
                June 2011
                : 74
                : 2
                : 017-024
                Affiliations
                [1 ] . Hospital de Niños J.M de los Ríos Venezuela
                [2 ] Universidad Simón Bolívar Venezuela
                Article
                S0004-06492011000200004
                0a1c0fec-af63-4649-877f-9f0ac7c7d5a1

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0649&lng=en
                Categories
                HEALTH CARE SCIENCES & SERVICES
                HEALTH POLICY & SERVICES
                PEDIATRICS

                Pediatrics,Health & Social care,Public health
                chronic renal disease,enfermedad renal crónica,crecimiento,evaluación nutricional,niños,growth,nutritional assessment,children

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