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Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 79

Nutrition in children with nephrotic syndrome

Consultant and Director, Department of Nephrology, MIOT Institute of Nephrology, MIOT Hospital, Chennai, Tamil Nadu, India

Date of Web Publication23-Apr-2019

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrnm.jrnm_3_19

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How to cite this article:
Ravichandran R. Nutrition in children with nephrotic syndrome. J Renal Nutr Metab 2018;4:79

How to cite this URL:
Ravichandran R. Nutrition in children with nephrotic syndrome. J Renal Nutr Metab [serial online] 2018 [cited 2020 Feb 21];4:79. Available from: http://www.jrnm.in/text.asp?2018/4/3/79/256821

Before we even start thinking about nutrition in a condition like nephrotic syndrome, we need to understand the dynamics of feeding, food, and nutrition in children. The foremost point to note that it is a primal instinct of parents from the time human race started to put food on the table for children. Hence, any conflict with the ideas fostered by parents about providing food to their children makes the entire advice stand on shaky grounds!

Second, there are numerous factors at play while feeding children. A constant tug of war between what you, as a doctor may want them to eat, what the parents may want to feed them and finally what the children may want to eat. Children keep pushing the boundaries on a daily…nay on an hourly basis, and any weakness in the parents is exploited ruthlessly!

Finally, many a diet sheet will remain a myth because of that single word…YUCK!! So it is important to address all these issues when nutrition is considered.

Nutrition in Nephrotic can be broadly considered in three main categories.

For those having the first episode (likely to be steroid sensitive), steroid-sensitive NS and infrequent relapsers, I don't think, a big deal has to be made about what nutrition is provided. The usual advice for a good balanced diet is good enough, but this opportunity should be taken to educate the parents and entire family about… EK CHAMACH KUM!! If the family restricts salt, the child perforce has to do it!

For frequent relapsers, if using agents such as tacrolimus and cyclosporine convert them into infrequent relapsers, the same advice holds true. Monitoring for medication effects is warranted.

The problem is with children who do not respond to medications or are on large doses of steroids for years together. Apart from salt restriction, it has been deemed logical to control their lipid levels by using appropriate statins though there are only two large long-term studies and they are not long enough to consider atherosclerotic changes. Diet suitable for steroid adverse effects is also needed especially with regards to sugar levels, weight gain, bone metabolism (adequate calcium and magnesium and Vitamin D). No controlled studies of high protein diet are available to make recommendations, but it seems logical to have a good protein diet.

Finally, in children with congenital nephrotic syndrome, who unfortunately will not respond to any medications, a high calorie, high protein diet with adequate mineral and vitamin intake will be required along with specific treatment and look into the syndromes that cause it.


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