Nephrotic syndrome is one of the discomforting conditions which several people, particularly kids, suffer from throughout the world. In Life Force, we usually come across more pediatric nephrotic syndrome cases as compared to adult Nephrotic syndrome patients. And, dietary care can help a lot when dealing with nephrotic syndrome. So, we will be going through dietary care in children suffering from Nephrotic syndrome in this blog.
Taking good care of your child during the treatment for nephrotic syndrome may require some changes to the lifestyle which often include changes in the diet. In our body, kidneys have an important role to perform; they filter out any extra water and harmful waste that the body doesn’t need from the foods we eat. When the kidneys no longer complete this important job, the patient may need to change the diet to limit certain nutrients that are considered unhealthy for the kidneys.
Dietary management centers on the problem of protein depletion, hyperlipidemia, salt and water retention, and a loss of carrier proteins for vitamins and minerals can help. A very high protein diet will alter GFR so it is important to limit protein to decrease hyperfiltration. A healthy diet for Nephrotic syndrome patients consists of low sodium (salt), low fat (1% or skim), dairy products, low cholesterol, lean cuts of meat, less red meat, more fish, and lots of fresh fruits and vegetables. The amount of protein and fluid intake of a patient with nephrotic syndrome depends on the patient’s current condition, age, and weight.
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The alteration of a diet of Nephrotic Syndrome patients will help to achieve the following:
1) To control the symptoms of patients with the syndrome e.g.: Oedema
2) To reduce the risk of progression of renal diseases
3) To optimize nutritional status
4) To prevent long-term complications. For instance, kidney failure.
5) To replace nutrients lost in the urine. For instance, vitamin D, zinc, etc.
Let us see the dietary and nutritional recommendations for Nephrotic Syndrome patients:
- Protein: There has always been debate on the recommendation of protein for Nephrotic syndrome patients. Earlier high protein diet was recommended for Nephrotic syndrome patients, but, now, studies came up showing a high protein diet is not appropriate for a Nephrotic syndrome patient as it may further damage the kidneys. But, moderate protein intake is mandatory to compensate for the protein loss in the urine. If the blood urea nitrogen (BUN) is elevated and oliguria is present, dietary protein must be restricted.
- Carbohydrate: The intake of carbohydrates should be high to spare protein for a breakdown. Carbohydrates should provide sufficient kilocalories for energy needs, and it should be given liberally. This will also reduce the catabolism of protein and prevent starvation ketosis.
- Lipids: In the case of elevated levels of cholesterol and triglycerides, limited total fat and cholesterol and decreased intake of concentrated sugars and alcohol is recommended.
- Sodium: To combat massive edema, sodium levels in the diet must be sufficiently reduced. The restriction of sodium varies with the degree of oliguria. If renal function is impaired, sodium is restricted to 500 mg to 100 mg/day. As recovery occurs, sodium intake may be increased. Edema can also lead to reduced appetite and anorexia. This can further reduce a patient’s nutritional intake leaving him/her at risk of malnutrition. In many cases, strict sodium restriction played a crucial role in the management of edema associated with Nephrotic Syndrome.
- Water: If the restriction is not indicated, fluids may be consumed as desired. Normal intake of water is advised unless GFR is reduced. Fluid restriction may be necessary if edema is massive.
- Potassium: Potassium is required in adequate amounts to compensate for the losses.
- Calcium: Additional amounts of calcium are needed in case of bone rarefaction.
- Micronutrients: The loss of micronutrients is not well-established with clinical manifestations of Nephrotic syndrome. However, it is felt that, if the patient adheres to a moderate protein diet and no added salt and low saturated fat diet, the extent of the proteinuria and edema formation is reduced and the loss of these important micronutrients is minimized.
- Calories: Since appetite is usually poor, much encouragement and support are needed. The food must be as appetizing as possible and in a form most easily tolerated. Diet should provide 35 Kcal/kg body weight daily.
The main aim of nutritional management for Nephrotic Syndrome is to replace protein loss by having an adequate intake of proteins. However, a high intake of protein must be avoided to prevent any tubular damage to the kidneys resulting due to the filtering of an excess of proteins. Sodium intake in diet should be low and fat intake should also be very less.
Foods that can be eaten in liberal amount include:
- Cow’s milk, skimmed milk, and yogurt.
- Wheat, cereals, sprouts, pulses, and legumes, such as tur dal, moong dal, rajma, chana, lentils, etc…
- Eggs, fish, chicken, lean meat, etc…
- Lots of vegetables and fruits
- Soups, sauces, chocolate, drinks, juices, etc… (but with low sodium content)
- Moderately low intake of vegetable oils, butter, and mayonnaise.
Foods to Avoided in Nephrotic Syndrome
Here are some foods which you should avoid when suffering from nephrotic syndrome.
1) Excess of protein should be avoided because a very high protein diet may cause tubular damage to the kidneys, as the kidneys will have to filter more of the proteins. However, an appropriate amount of protein must be ingested to compensate for the loss of protein in the urine.
2) The high amount of fats should be avoided as cholesterol and triglyceride levels happen to be high in patients with Nephrotic syndrome. The diet should be high in calories to preserve protein and low in fat.
3) Excess of oily food and saturated fats, such as ghee, margarine, etc., should be avoided.
4) Sodium in the diet should be restricted to prevent fluid accumulation and edema. The foods that are high in sodium content and that should be avoided include:
– Salted wafers, salted biscuits, snacks, chips, popcorn, etc.
– Papads: All varieties
– Salted pickles, chutneys, curry powder, and commercial preparations
– Commercial salads, dressings, and sauces
– Bakery products, bread, and biscuits
– Salted cashew nuts, pistachio, walnuts, and peanuts
– Commercial cheese, preservative containing foods, noodle mixes, and portions of pasta
– Salted or canned meat
– Foods containing baking soda and Ajinomoto
– Soya sauce
– Smoked or tinned fish
– Monosodium glutamate and baking soda.
Let me conclude by stating that dietary management plays an important role in the management of Nephrotic syndrome. If dietary management is not practiced or followed regularly, Nephrotic syndrome condition can worsen further, thereby resulting in complications leading to damage to the kidneys. Hence, restricted protein, high carbohydrate diet, salt restriction with moderate fat, and restricted fluid is what is recommended for a Nephrotic syndrome patient. Vitamin supplements, particularly vitamin C, need to be supplemented along with the modified diet to ensure better health for the long future.