Well, week six is my renal rotation. At the begging I was not excited. Renal has never really been an interest of mine because I had the mindset that those who are on dialysis have generally made poor lifestyle choices and put themselves in this awful position. But here we are at the end of the week and RENAL NUTRITION IS AWESOME!
So first off, I have a soft spot for specialty diets. I love the challenge of putting together a diet that meets a patients micro and macronutrient needs. With the renal diet, patients need to manage, fluid, protein, potassium, sodium, calcium, and phosphorus. The extent to which these need to be managed depends on the severity of their disease state. What I learned as a renal dietitian, is your job is to help the patient manage their disease without eliminating their favorite foods entirely.
This brings me to the second reason I think I changed my mind about renal nutrition. I am working in a children’s hospital and kids have not brought these problems upon themselves. They are victims of circumstance. You want to help these patients live the best quality of life because they have so much more life to live. The ultimate goal for patients with CKD is to get a kidney transplant.
Kiddos with CKD aren’t the only ones who may need a kidney transplant. There are a lot of patients on the transplant list because of acute damage to the kidney cause from an infection or other event. On the inpatient side of renal nutrition relating to transplants, food safety is a huge issue. Patients need immunosuppressants to prepare for their new kidney and they will also be on immunosuppressants the rest of their life so this education can be vital to the success of the patient long-term. Additionally, I learned about the importance of general nutrition education to keep the new kidney healthy long term.
The one thing about working in a children’s hospital is that parents can be your best friend or your worst enemy. It can be really hit or miss and generally they have good intentions but what they think is beneficial for their child may also hinder the child’s progress. This can be a barrier that difficult to over come and takes some insane counseling skills.
I had a few different preceptors during this week in renal and they were all amazing. But my main preceptor walked me through the function of the kidney and how it interacts with other parts of the body and in turn why the nutrition recommendations are so important. This changed my world. The kidneys are complicated but understanding the physiology really helped me understand other body systems as well, specifically the cardiovascular system. So if you have a chance to dive into this topic I highly recommend it! Maybe I’ll do a kidney physiology post in the future because this is seriously one of the most beneficial things I have learned so far.
Fun fact to close out my week on the renal service. The one thing patients with kidney disease can NEVER eat is starfruit. Something in the fruit causes the kidneys to release a neurotoxin and can cause neurological disorders and even death in some cases.