or nauseous. Fortunately, dialysis side effects can
often can be treated quickly and easily.
In patients receiving dialysis, a type of protein
called beta-2-microglobulin builds up in the blood.
As a result, beta-2-microglobulin molecules tend to
join together to form aggregated molecules (amy-
loids). These aggregates can form deposits and even-
tually damage the surrounding tissues while causing
significant discomfort. This condition is called dialy-
sis–related amyloidosis (DRA). DRA is relatively
common in patients, especially older people, who
have been on hemodialysis for more than five years.
This is because dialysis membranes after being used
for several years do not effectively remove the beta-2-
microglobulin amyloids from the bloodstream. New
hemodialysis membranes, as well as peritoneal dialysis,
remove beta-2-microglobulin more effectively, but not
enough to keep blood levels normal. As a result, blood
levelsremainelevated,anddepositsforminbone, joints,
and tendons.
Parental concernsThe two major problems faced by children with
kidney failure are poor growth and weight gain, so
their diet is usually not restricted unless needed. Chil-
dren grow fastest during the first two years of life and
the earlier the age at which kidney failure occurs, the
more likely is growth to be affected. The goals in feed-
ing a child with kidney failure are to balance nutrition
for normal growth and protect health as well. The
treating physician works with a dietitian to monitor
possible problems and suggests, if needed, a diet that
will try to take into account the child’s food likes and
dislikes.
Parents should learn as much as they can about a
child’s kidney disease and its treatment, encouraging
the child to ask questions not only to family members
but also to doctors, nurses, and other members of the
care team. This also includes explaining the special
nutrition restrictions of kidney disease. If explained
clearly and simply, even very young children can
understand special dietary needs. It is found on the
whole that children are in general more compliant with
dietary restrictions than adults. One way to help chil-
dren develop a sense of control over the illness is to
have a child make a list of favorite foods and take him
or her along to dietitian appointments to see if these
foods can be incorporated into the diet plan. Trying to
bribe or force a child to eat is ill-advised and counter-
productive. Helping a child understand kidney dis-
ease, its treatment and the purpose of the special diet
is the only way to ensure dietary compliance while
maintaining a positive climate of support and
encouragement.Resources
BOOKS
Colman, S., Gordon, D.Cooking for David: A Culinary
Dialysis Cookbook.Huntington Beach, CA: Culinary
Kidney Cooks, 2006.
Garrison, R., Somer, E.The Nutrition Desk Reference.
New York, NY: McGraw–Hill, 1998.
Mitch, W. E., Klahr, S.Handbook of Nutrition and the
Kidney.Conshohocken, PA: Lippincott Williams &
Wilkins, 2005.
Netzer, C. T.The Complete Book of Food Counts.New York,
NY: Dell Publishing Co., 2005.
Pennington, J. A. T., Douglass, J. S.Bowes and Church’s
Food Values of Portions Commonly Used.Philadelphia,
PA: J.P. Lippincott Co., 2004.
Suzuki, H., Kimmel, P. L.Nutrition and Kidney Disease: A
New Era.Basel, CH: S Karger Pub, 2007.
Wiggins, K. L., ed.Guidelines for Nutrition Care of Renal
Patients.Chicago, IL: American Dietetic Association,
2002.
ORGANIZATIONS
American Association of Kidney Patients (AAKP). 3505 E.
Frontage Rd., Suite 315, Tampa, FL 33607. 1-800-749-
2257.<www.aakp.org>.
American Dietetic Association (ADA). 120 South Riverside
Plaza, Suite 2000, Chicago, IL. 60606-6995. 1-800/877-
1600.<www.eatright.org>.
American Society for Nutrition (ASN). 9650 Rockville Pike,
Bethesda, MD 20814. (301) 634-7050.<www.nutrition
.org>.
National Kidney Foundation. 30 East 33rd Street, New
York, NY 10016. 1-800-622-9010.<www.kidney.org>.
National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC). 3 Information Way,
Bethesda, MD 20892–3580.<kidney.niddk.nih.gov>.
Renal dieticians (RPG). 120 South Riverside Plaza, Suite
2000, Chicago, IL. 60606-6995. 1-800-877-1600 ext.
4815.<www.renalnutrition.org>.Monique Laberge, Ph.D.Riboflavin
Definition
Riboflavin is a water-soluble vitamin that the
body needs to remain healthy. Humans cannot make
riboflavin, so they must get it from foods in their diet.
Riboflavin is also called vitamin B 2.Riboflavin