I think the average patient is aware of the importance of food and drink in helping the body heal and recover from ill-ness. Nearly always is the question asked. “Doctor is there anything special I should or should NOT eat or drink?” Apart from special medications prescribed by the physician, there are a few other diseases of the body, apart from diabetes, when fluids and the correct food are so vital. Patients are exhorted to drink plenty of fluids (excluding alcohol) if they have kidney or bladder infection. The increased fluid helps “flush” the kidneys and bladder and helps get the medication prescribed through the kidneys and bladder to pro-mote healing and rapid recovery. A well-balanced diets also promotes healing of tissues, wherever damaged. A special exception to the edict “drink plenty of fluids” is in the case of kidney failure. Most of us know that the kidneys excrete the poisonous wastes accumulated in the body, and that they also excrete water. If the kidneys are not working properly, to the extent that they cannot get rid of the excess water in the system, or the poisonous wastes, then it is vital that the intake of food and fluid be modified so as to put as little strain as possible on the damaged kidneys. In this particular instance, then – the kidney failure (NOT kidney infection) – the patient is advised to restrict fluids (i.e. to consume as little water as possible) or else the excess will accumulate in the face causing puffy eyes; the hands and feet become swollen. This type of swelling does NOT go down overnight – in fact it will not go down even with diuretics (“water tablets” as they are commonly known) because the kidneys are too “ill” to respond. Therefore it is imperative that the sufferer from kidney failure keep his fluid intake down to the prescribed amount. It is often necessary also to restrict protein intake (i.e. meat, fish, eggs, ham, pork), as the wastes made from these foodstuffs cannot excreted by the ailing kidney and accumulate to poisonous levels in the patient’s blood stream. These poisonous wastes cause headaches, itching in the skin, twitching of the muscles, severe weakness and lassitude sometimes leading on to coma and even death. Hence, in cases of kidney failure the protein in the diet has to be severely restricted. The third substance which often has to be restricted is salt – that glorious substance which makes most foods taste so good. We feel that we may as well be given life imprisonment as to be told we cannot have salt in our food. Well, salt can be harmful because: It causes blood pressure to remain high and it is a known fact that high blood pressure, which causes strokes, heart attack and kidney failure, is one of the major causes of death in the Bahamas.It causes the body to retain fluid, especially water. This results in swelling of the face, hands and feet. This fluid also collects in the lungs and causes shortness of breath so that the sufferer can hardly get dressed without stopping two or three times to “catch a breath”.This excess fluid can precipitate heart failure, which is often fatal. These then are the basic restrictions as regards to fluid and diet in certain types of kidney disorders. What then may the poor patient eat? If the condition is one of kidney failure, then the diet is vital to survival. Fluids must be restricted so as to avoid swelling and congestion of the heart, lungs and brain. Protein and salt must be restricted according to the degree of failure of the kidneys. The doctor must give the individual patient a special diet sheet which the patient should place in a visible place and not in a drawer where it will be forgotten. Foods good for kidney infections are water, milk, tea, (fruit juices may be good for some, too acid for others), meat, fish, conch, rice, grits and vegetables such as cabbage, carrots, sweet peppers, okra. Foods safe for kidney failure patients are unfortunately restricted to low salt small amounts of protein, e.g. one to two eggs per week or one portion of fish every three days; plenty of rice, grits, potatoes, a small amount of oatmeal, some jams and jellies, fruits low in potassium content, bread. These patients must be on diets made up to fit the particular aspects of their kidney failure. As soon as such a patient can get artificial kidney treatments or dialysis, then the diet is made less rigid and a greater variety of food may be enjoyed. The best course is always to ask what is safe to eat or drink – and when told, to take heed of the advice given. “it is vital that the intake of food and fluid be modified so as to put as little strain as possible on the damaged kidneys”

I think the average patient is aware of the importance of food and drink in helping the body heal and recover from ill-ness. Nearly always is the question asked. “Doctor is there anything special I should or should NOT eat or drink?” Apart from special medications prescribed by the physician, there are a few other diseases of the body, apart from diabetes, when fluids and the correct food are so vital. Patients are exhorted to drink plenty of fluids (excluding alcohol) if they have kidney or bladder infection. The increased fluid helps “flush” the kidneys and bladder and helps get the medication prescribed through the kidneys and bladder to pro-mote healing and rapid recovery. A well-balanced diets also promotes healing of tissues, wherever damaged. A special exception to the edict “drink plenty of fluids” is in the case of kidney failure. Most of us know that the kidneys excrete the poisonous wastes accumulated in the body, and that they also excrete water. If the kidneys are not working properly, to the extent that they cannot get rid of the excess water in the system, or the poisonous wastes, then it is vital that the intake of food and fluid be modified so as to put as little strain as possible on the damaged kidneys. In this particular instance, then – the kidney failure (NOT kidney infection) – the patient is advised to restrict fluids (i.e. to consume as little water as possible) or else the excess will accumulate in the face causing puffy eyes; the hands and feet become swollen. This type of swelling does NOT go down overnight – in fact it will not go down even with diuretics (“water tablets” as they are commonly known) because the kidneys are too “ill” to respond. Therefore it is imperative that the sufferer from kidney failure keep his fluid intake down to the prescribed amount. It is often necessary also to restrict protein intake (i.e. meat, fish, eggs, ham, pork), as the wastes made from these foodstuffs cannot excreted by the ailing kidney and accumulate to poisonous levels in the patient’s blood stream. These poisonous wastes cause headaches, itching in the skin, twitching of the muscles, severe weakness and lassitude sometimes leading on to coma and even death. Hence, in cases of kidney failure the protein in the diet has to be severely restricted. The third substance which often has to be restricted is salt – that glorious substance which makes most foods taste so good. We feel that we may as well be given life imprisonment as to be told we cannot have salt in our food. Well, salt can be harmful because: It causes blood pressure to remain high and it is a known fact that high blood pressure, which causes strokes, heart attack and kidney failure, is one of the major causes of death in the Bahamas.It causes the body to retain fluid, especially water. This results in swelling of the face, hands and feet. This fluid also collects in the lungs and causes shortness of breath so that the sufferer can hardly get dressed without stopping two or three times to “catch a breath”.This excess fluid can precipitate heart failure, which is often fatal. These then are the basic restrictions as regards to fluid and diet in certain types of kidney disorders. What then may the poor patient eat? If the condition is one of kidney failure, then the diet is vital to survival. Fluids must be restricted so as to avoid swelling and congestion of the heart, lungs and brain. Protein and salt must be restricted according to the degree of failure of the kidneys. The doctor must give the individual patient a special diet sheet which the patient should place in a visible place and not in a drawer where it will be forgotten. Foods good for kidney infections are water, milk, tea, (fruit juices may be good for some, too acid for others), meat, fish, conch, rice, grits and vegetables such as cabbage, carrots, sweet peppers, okra. Foods safe for kidney failure patients are unfortunately restricted to low salt small amounts of protein, e.g. one to two eggs per week or one portion of fish every three days; plenty of rice, grits, potatoes, a small amount of oatmeal, some jams and jellies, fruits low in potassium content, bread. These patients must be on diets made up to fit the particular aspects of their kidney failure. As soon as such a patient can get artificial kidney treatments or dialysis, then the diet is made less rigid and a greater variety of food may be enjoyed. The best course is always to ask what is safe to eat or drink – and when told, to take heed of the advice given. “it is vital that the intake of food and fluid be modified so as to put as little strain as possible on the damaged kidneys”

Kidney disease can and does occur in children. Pediatric kidney disease presents a unique public health challenge as it is relatively rare but often severe with various etiologies. It is usually overshadowed by kidney disease in the adult population where it is more common and burdensome. However, pediatric kidney disease certainly requires the same level of awareness an advocacy as adult disease because of the implications on growth, development, quality of life, and burden to the public health care system. Many children with kidney disease go on to have chronic kidney disease (CKD) or chronic renal disease. In this condition, the kidneys are permanently damaged, do not get better with treatment, and worsen over time. Ultimately, the child may require renal replacement therapy in the form of dialysis or transplantation. Kidney disease affects approximately 1574 children per 1 million and all ages and races are affected. Over the past 20 years, the incidence of chronic kidney disease in children has steadily increased. The kidneys are two bean shaped organs that are located below the ribs. They are responsible for filtering the blood of waste and extra water and produce urine to get rid of these. But it doesn’t stop there. The kidneys are also responsible for removing extra acid from the body and maintaining a healthy balance of salts and minerals. The kidneys make hormones that control blood pressure, make red blood cells, and interacts with a hormone that promotes healthy growth. With this understanding, it is very easy to understand how CKD can lead to myriad of problems in childhood. Children with CKD may have no symptoms at all. If they do have symptoms, they may include swelling because of decreased urination, some disease may cause frequent urination or prolonged bedwetting, poor growth, loss of appetite, nausea, fatigue, headaches related to elevated blood pressure, and anemia from decreased red cell production. The medical challenges are only the start of the story. As one may expect, kidney disease has a tremendous impact on the quality of life for the child and the family members. Children often struggle to achieve independence from their parents because of the complexity of their health condition. Additionally, they often encounter relationship problems, learning and behavior problems, and have delayed language and motor skill development. Other siblings in the household may suffer neglect because of the amount of support that is required to care for a child with CKD. The cause of kidney disease in children is very different from the more common causes in adults. Infants and children are more likely to suffer from birth defects, congenital, and hereditary disease. Teenagers are affected by glomerulonephritis which occurs because of swelling and inflammation of the kidney, infect ion, nephrotic syndrome, and urine blockage or reflux. Many causes of CKD in adults have their origins in childhood. The obesity epidemic in childhood has given rise to the increased prevalence of noncommunicable diseases in children. Obesity often leads to hypertension and diabetes, both leading causes of CKD in adults. Even with the best treatment, pediatric CKD patients have increased morbidity and mortality when compared to their age matched peers. Children with CKD have a shortened lifespan compared to children without kidney disease. Those that require dialysis have a mortality rate that is 30 times higher than other children. The leading cause of death is usually related to cardiovascular disease or infection. The importance of CKD and kidney failure in children should not be understated as it carries with significant impact. Kidney transplantation is the preferred form of renal replacement therapy in children as it can help with maximizing their growth, development, and increases their survival with compared to dialysis. While there is no cure, renal transplantation provides as close to a second chance as is humanly possible. Every child should have a second chance!