Nutrition in chronic renal insufficiency in the first year of life

: In the first year of life, period of maximal anabolism, optimal metabolic and nutritional conditions are strictly required. In fact growth retardation of the infant is seldom recoverable in the following pediatric ages. Conservative management of chronic renal failure in the first year of life is essentially dietetic. Normal growth is warranted by adequate protein intake (6-8% of total calories) and optimal caloric support (> 75-80% of RDA). Water requirements (evaluated on the basis of diuresis, hydratation and weight variations) must be administrated during the whole 24-hours period to avoid dehydration. Sodium and potassium limitations are not generally indicated and only in advanced phases must be carefully evaluated. On the contrary, in early stages, a reduction of phosphorus intake and calcium and vitamin D supplementation are commonly suggested. Maternal milk is the nutritional gold standard during the first year of life. Hyposmolar formula with normal Na and low P content (Ca/P ratio = 1.4-2) and a protein content comprised between 1.4 and 1.8 g/100 ml represent the second choice.