Renal Dieticians' Role

So I think there was a question voiced about uh nutrition with renal dietitians. Um, so I always laugh and say that the renal dietitians in our clinic do 80% of the work and my job is just to support them. Um, but really from a renal dietitians standpoint, indications for a child to be seen by a renal dietitian would be, um, if they do have some CKD and they have, um, abnormal growth, primarily, uh, growth failure, we usually define that as a height less than the 3rd percentile, um, for age and gender. Um, but also kids who maybe are on the growth chart, but for some reason, both of their parents are very tall and they're much, much shorter. Um, those would be indications. Another one would be if, um, the child's kidney function cannot support a normal potassium, um, a normal calcium, or a normal phosphorus, and also whenever we can see some abnormalities in albumin. So, those are typically indications for their renal dietitian. Um, and again, many times when we're trying to sort through this, we're trying to understand if this is a feeding problem that would require things such as a feeding tube, um, either through the nose called a nasogastric tube or NG tube, or something, um, that's through the abdomen, usually right here, um, called a gastrostomy tube or a G tube. Um, so those are pretty common. Um. Because sometimes, um, patients with pretty severe renal disease, especially infants and young children, it just takes a lot of physical activity or energy for them to eat. And so what we need to understand is that we can get the amount of calories they need and the amount of fluid they need. Um, without impeding their ability to use the energy and calories for growth. Um, and again, the other thing where they can become very involved is if we need to figure out how to manage the formula in order to keep their potassium normal and some of their other electrolytes normal. Um, again, we are very blessed to have two wonderful renal dietitians, um, who are very engaged with the families. Um, I will also say we also in chronic kidney disease have a nurse coordinators as well, um, that also can coordinate with Nicole. Um, so again, if you're someone whose child has significant kidney disease, as well as having PUV. Um, you actually have the luxury of having two nurses that can really help ensure that your visits are coordinated, that you can see all the people you need to see, and also to have a kind of a voice in between visits, because we know that, um, you have to take this child home and there's things that come up that you didn't think about asking or just things come up in your child's life and you need to understand, you know, do I need to come in and be seen? Is there anything I can do at home, um, and also just what else do I need? And again, people like Nicole and our CKD coordinators are invaluable, and they can help you get in touch with people like the renal dietitian or everyone else. And I wanted to just say when we talked earlier about some of the screenings that Don, that Doctor Clay and. Um, has helped us with also the renal dietitians have given some, um, guidelines and some things to look at like a lot of things she just touched on, but so then that way if there are needs, um. That come up I can always touch base with them they're very available, which is very nice, especially too as our um patients are getting older and when they start getting involved in sports and things like that protein and things like that sometimes have become an issue and I've had some families ask questions like that and they're very available so we're able to um really work closely together for those things.