Nutritional management of chronic renal failure in childhood.

Protein malnutrition is common in children with chronic renal failure (CRF) and is especially severe in young infants. Growth is usually rapid in infants and CRF causes a reduction in cell mass associated with extreme growth retardation in this age group. Poor energy intake and altered energy metabolism are common in CRF and are associated with protein malnutrition and poor growth. Uraemic toxicity may reduce protein synthesis by altering energy metabolism or by a direct effect, low protein high energy diets improve growth and extremely low nitrogen intakes supplemented with essential amino acids and keto acids may be useful in selected children.