Journal of Medical Council of Iran
Volume 43, Issue 4 (2025)
jmciri 2025, 43(4): 74-78 |
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Mostafaei Z, Heshmatipour H, Zeydi M, Rouhani M H. Impact of Medical Nutrition Therapy on Growth and Cardiovascular Risk Factors in a Pediatric Patient with End-Stage Renal Disease and Neurogenic Bladder: A Case Report. jmciri 2025; 43 (4) :74-78
URL: http://jmciri.ir/article-1-3405-en.html
URL: http://jmciri.ir/article-1-3405-en.html
Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract: (9 Views)
Background: Despite the numerous advances made over the last few decades in the management of children with chronic renal disease. Children with End-Stage Renal Disease (ESRD) characteristically do not reach their genetic potential in height, even if their final stature is within the normal reference ranges.
Case report: A nine-year-old boy suffered from ESRD, with a history of neurogenic bladder. The patient received hemodialysis twice a week. Upon initial referral to a nutritionist, lab results revealed elevated blood phosphorus levels at 7 mg/dL and high blood cholesterol at 133 mg/dL, along with a creatinine level of 4.9 mg/dL. Sodium, Potassium, Calcium, Hematocrit, Hemoglobin, and Triglyceride levels were within normal ranges. The BUN level was 47.5 mg/dl before hemodialysis and dropped to 10.5 mg/dl after the session. Serum albumin was measured at 4.3 g/dl. The patient’s Body Mass Index (BMI)-for-age Z-score was 0.51, and the height-for-age Z-score was 0.26. Additionally, the patient exhibited a poor appetite.
The patient’s initial diet, providing 2250 Kcal per day with a macronutrient distribution of 53.5% carbohydrates, 12.4% protein, and 29.6% fat. The diet included 1 serving of dairy, 9 servings of grains, 6 servings of sugars, 5.5 servings of meats, 0.5 servings of legumes, 0.5 servings of nuts, and 6 servings of fats. The patient consumed three servings of fruit daily, consisting of two medium-potassium fruits and one high-potassium fruit. The diet also included one serving of a low-potassium vegetable and two medium-potassium vegetables.
After several sessions of medical nutrition therapy, the patient’s weight increased from 35.7 kg to 42.4 kg, and his height increased from 139 cm to 145 cm. Improvements were also observed in BMI-for-age and height-for-age Z-scores. Phosphorus levels decreased significantly, and cholesterol levels improved.
Conclusion: The findings suggest that medical nutrition therapy positively impacts cardiovascular risk factors and promotes growth in children with kidney disease.
Case report: A nine-year-old boy suffered from ESRD, with a history of neurogenic bladder. The patient received hemodialysis twice a week. Upon initial referral to a nutritionist, lab results revealed elevated blood phosphorus levels at 7 mg/dL and high blood cholesterol at 133 mg/dL, along with a creatinine level of 4.9 mg/dL. Sodium, Potassium, Calcium, Hematocrit, Hemoglobin, and Triglyceride levels were within normal ranges. The BUN level was 47.5 mg/dl before hemodialysis and dropped to 10.5 mg/dl after the session. Serum albumin was measured at 4.3 g/dl. The patient’s Body Mass Index (BMI)-for-age Z-score was 0.51, and the height-for-age Z-score was 0.26. Additionally, the patient exhibited a poor appetite.
The patient’s initial diet, providing 2250 Kcal per day with a macronutrient distribution of 53.5% carbohydrates, 12.4% protein, and 29.6% fat. The diet included 1 serving of dairy, 9 servings of grains, 6 servings of sugars, 5.5 servings of meats, 0.5 servings of legumes, 0.5 servings of nuts, and 6 servings of fats. The patient consumed three servings of fruit daily, consisting of two medium-potassium fruits and one high-potassium fruit. The diet also included one serving of a low-potassium vegetable and two medium-potassium vegetables.
After several sessions of medical nutrition therapy, the patient’s weight increased from 35.7 kg to 42.4 kg, and his height increased from 139 cm to 145 cm. Improvements were also observed in BMI-for-age and height-for-age Z-scores. Phosphorus levels decreased significantly, and cholesterol levels improved.
Conclusion: The findings suggest that medical nutrition therapy positively impacts cardiovascular risk factors and promotes growth in children with kidney disease.
Type of Study: case report |
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