1.What is chronic kidney disease?
Chronic kidney disease (CKD) is defined as kidney damage or a glomerular filtration rate (GFR) <60ml/min/1.73m2 for more than 3 months. Kidney damage is defined as pathology, or blood, or urine, or imaging tests suggesting kidney abnormalities.
2.How is chronic kidney disease staged?
There are 5 stages
Stage 1: renal damage, GFR ≥ 90ml/min/1.73m2
Stage 2: renal damage, GFR 60~89ml/min/1.73m2
Stage 3: renal damage, GFR 30~59ml/min/1.73m2
Stage 4: renal damage, GFR 15~29ml/min/1.73m2
Stage 5: renal impairment, GFR<15< span="">ml/min/1.73m2 or dialysis
3.How to assess glomerular filtration rate (GFR)?
Multiple assessment methods, each with advantages and disadvantages
Recommended method.
Low birth weight infant, birth weight <2.5 kg< span="">, 0 to 12 months: classic Schwartz formula, 29.1 × length (cm)/blood creatinine (μmol/L)
Full-term infants, 0 to 12 months: classical Schwartz formula, 39.7 × length (cm)/blood creatinine (Cr, μmol/L)
Children, 1-17 years: modified Schwartz formula, 36.5 × length (cm)/blood creatinine (Cr, μmol/L)
Those with abnormal muscle volume or abnormal body posture: serum cytochrome C level is recommended
Acute kidney injury: serum cytochrome C level is recommended for judgment (reference value 0.7~1.38mg/L)
4.Chronic kidney disease diet management
Different chronic kidney disease stages, different ages, different activity levels require different ratios of calories and nutrients. The intake of cholesterol, trans fatty acids and saturated fatty acids in the diet should be as little as possible.
Foods with high cholesterol content.
Pig brain, egg yolk, salted duck egg, pine egg, lamb head meat, quail egg, crab yolk, shrimp skin, liver, pig kidney, etc. In addition, a large amount of sugar intake can aggravate hyperlipidemia
Foods containing more trans fatty acids.
Cakes, pastries, cookies, bread, Indian toss, salad dressing, French fries, potato chips, popcorn, chocolate, ice cream, custard pie, etc., all fluffy and sweet, unique taste of oil-containing (vegetable cream, margarine, etc.) food, all contain trans fatty acids (Baidu Encyclopedia)
Foods containing saturated fatty acids.
Animal fats such as butter, cream and lard contain more saturated fatty acids than vegetable fats. Coconut oil, cocoa butter, and palm oil are also rich in saturated fatty acids. Animal foods are the richest in fat and mostly saturated fatty acids (Baidu Encyclopedia)
Children with chronic kidney disease need to supplement with essential vitamins and trace elements
B1, B2, B3, B5, B6, B8, B12, C, A, E, K, folic acid
Micronutrients (copper and zinc)
Water-soluble vitamin supplements for children on dialysis
Management of hyperhomocysteinemia.
Folic acid supplementation, maximum 2.5mg/d for infants, 2.5mg/d for 1-5 years, 5mg/d for children over 5 years
Avoid excessive alcohol, coffee or strong tea, smoking, high fat diet (including excessive red meat)
Avoid entering large amounts of salt
Maintain proper exercise
Relieve mental stress
Dietary management of hyperuricemia.
Limit intake of purine-rich foods
Drink plenty of water
Consume more fruits and vegetables
Maintain body weight in normal range
Limit fat intake in hyperlipidemia
Prefer not to eat animal offal, fish and shellfish, broth, yeast powder
Prefer cereals and potatoes (such as rice, millet, wheat, potatoes), vegetables, fruits, eggs, milk, etc.
5.Anemia management for chronic kidney disease
Multifactorial causes of anemia.
Iron or folic acid deficiency
Shortened life span of red blood cells
Secondary hyperparathyroidism
Aluminum toxicity
Inhibition of erythropoiesis, etc.
Reduced erythropoietin is the most important cause of anemia in renal failure
Target value for anemia correction: hemoglobin 11-12 g/dL (HCT 33%)
Tests for anemia.
Hb, MCV, MCH, MCHC
Reticulocyte count
Iron tests (serum ferritin, transferrin saturation)
Treatment of anemia.
Adequate nutrition
Correction of hyperparathyroidism
Avoid aluminum toxicity
Treat chronic infection and inflammation
Supplementation of hematopoietic materials such as iron (2~6mg/kg/d in 2~3 doses, 2 hours before or 1 hour after meals), folic acid, vitamin B12
If hemoglobin <11g/dL consider erythropoietin treatment
6. Abnormal bone mineral metabolism in chronic kidney disease
It refers to abnormalities in calcium, phosphorus, parathyroid hormone, vitamin D metabolism, abnormal bone metabolism, vascular or other soft tissue calcification, etc.
Evaluation indicators: blood calcium, phosphorus, alkaline phosphatase, bicarbonate, parathyroid hormone, vitamin D
Skeletal imaging, bone density analysis (not as routine), even bone biopsy if necessary
Treatment.
Control blood phosphorus levels, limit phosphorus intake, use phosphorus binding agents if necessary
Control calcium levels and calcium-phosphorus product levels
Calcium intake in children
0~0.5 years, 210mg/d
0.5~1 year old, 270mg/d
1~3 years, 500mg/d
4~8 years old, 800mg/d
9~18 years old, 1300mg/d
>18 years old, 1000mg/d
Without vitamin D, 19% of calcium intake is absorbed in the digestive tract; with vitamin D, 25% of calcium intake is absorbed in the digestive tract
Avoid calcium chloride in patients with uremia
Avoid calcium citrate in patients receiving aluminum therapy
Prevent hypercalcemia (blood calcium >2.54 mmol/L); if it occurs, stop calcium and vitamin D supplementation until blood calcium is normal
Compiled by: Guan Na, Department of Pediatrics, Peking University First Hospital
Academic controversy, the content of this science is for reference only
Reference.
Huikim Yap, Isaac Desheng Liu, Woo-Chiao Tay. Pediatric Nephrology On The Go
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