PRINCIPLES OF DIETARY MANAGEMENT
Because uremia is seen in advanced renal insufficiency, the diet must take into account not only the protein content but also the acid-base balance and fluid and electrolyte balance too.

However in the world of modern scientific inventions, dialysis has proved to be a boon. In this technique, the toxins from the body are artificially cleared by a semipermeable membrane either from the blood (hemodialysis) or from the abdomen (peritoneal dialysis). The dietary modification must take into account the following considerations.

• To provide adequate calories
• To regulate the protein content of the diet
• To regulate sodium, potassium and fluid intake
• To restrict phosphate and supplement the diet with calcium, iron, trace minerals, ascorbic acid and the B-complex vitamins,
• To aim for palatability (taste).Most diets fail to achieve their aims simply because children are unable or unwilling to tolerate them.
• To avoid starvation and to feed the children frequently. Renal function deteriorates and blood urea levels rise rapidly owing to tissue breakdown under conditions of starvation.

Energy: Energy is derived from foods, which contain carbohydrates, proteins and fats. Sufficient energy should be provided in the diet or else the body tissues will be broken down to provide energy. This should be avoided as all tissues are mainly protein in nature and if broken down they increase the urea and creatinine levels.

Protein: The body reserves proteins for growth, maintenance and repair of body tissues. It is important for every cell in the body. It is present in almost all the foods but the quantity and quality varies. Proteins of high biological value or 'good quality' are found mainly in eggs, milk, meat, fish and poultry. Proteins of lower biological value are found in pulses, cereals, nuts, oilseeds and in some vegetables like greenpeas and dried beans. Normally 0.8-1.0gm/kg of body weight protein is effective.