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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 80-81

Diet in nephrotic syndrome


Dietitian, Department of Dietetics, B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India

Date of Web Publication23-Apr-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_2_19

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How to cite this article:
Paranjape J. Diet in nephrotic syndrome. J Renal Nutr Metab 2018;4:80-1

How to cite this URL:
Paranjape J. Diet in nephrotic syndrome. J Renal Nutr Metab [serial online] 2018 [cited 2019 Jul 15];4:80-1. Available from: http://www.jrnm.in/text.asp?2018/4/3/80/256820



Nephrotic syndrome (NS), as we know it today, is a combination of proteinuria, hypoalbuminemia, hyperlipidemia, and edema, a concept that took some time to be developed. Interestingly, the effective treatments became available only recently in the mid-1900s, with the advent of steroids, antibiotics, diuretics, and other immunomodulators.

Even today, there is a gap in our understanding of the etiology of NS of childhood, and better treatments are still required in the more resistant forms. NS as such is a combination of clinical and laboratories findings that is seen with a variety of pathologic lesions affecting the glomerulus.

One observation by Hippocrates was “when bubbles settle on the surface of the urine, it indicates a disease of the kidney and that the disease will be protracted.”

Over the next few years, the various lipid abnormalities in NS became the forefront of discussion.

NS is a common clinical condition in Asian children. The prevalence of minimal change NS is also higher in the Indian subcontinent. The incidence of childhood NS is reported as 4.7 (range 1.15–16.9) per 100,000 children worldwide. In several European studies, South Asian children were reported to have a higher incidence of NS than the European population.

The mean age at onset has been reported to be 3.4 years in Asians and 4.2 years in Europeans. In young children, boys are more commonly affected than girls (ratio 3:2); however, in teenagers and adults, the sex ratio is approximately equal.

NS is defined by the presence of:

  • Heavy proteinuria (proteinuria is considered to be in the nephrotic range when the urine protein is 3+/4+ on a dipstick test, spot protein/creatinine ratio >2 mg/mg, or urine albumin >40 mg/m2 per h (on a timed sample)
  • Serum albumin <25 g/L
  • Edema
  • Hyperlipidemia (serum cholesterol >200 mg/dL).



  Dietary Management Top


Reducing proteinuria should be the primary goal.

Although the NS results from the loss of plasma proteins into the urine, high protein diets are ineffective in correcting the metabolic consequences of urinary protein loss. Furthermore, diets rich in protein increase proteinuria and may accelerate the course of a variety of renal diseases. Thus, dietary supplements to provide high protein intakes should be avoided. Dietary protein restriction not only reduces proteinuria but also preserves serum albumin concentration. Moreover, modest protein restriction (0.8 g/kg/day) has been shown to maintain nitrogen balance. The studies utilizing an extremely low protein diet (0.3 g/kg/day) supplemented with essential amino acids are provocative but need to be verified by larger controlled trials objective in the treatment of the NS. This is one view.

On the other hand, according to the Japanese Society of Nephrology, the amount of protein intake be based on the nutrient requirement for healthy children of the same age, considering both the unlikelihood of progression to renal failure and their growth. Moreover, according to the Indian Pediatric Nephrology Group (IPNG), a balanced diet, adequate in protein (1.5–2 g/kg) and calories, is recommended. Patients with persistent proteinuria should receive 2–2.5 g/kg of protein daily.

The management of hyperlipidemia is controversial and could be of some importance if the nephrotic state is prolonged. The manipulation of dietary fat intake has a limited effect in reducing serum lipids. Dietary therapy with a low-fat diet, however, is generally of only minimal benefit, and there is no long-term experience with the use of a low-fat diet in the treatment of the hyperlipidemia of the NS. In addition, there is no compelling reason to prescribe unsaturated fatty acid supplements (such as fish oil) until results from controlled studies are available. It is best to include low cholesterol and saturated fatty acid diets. According to the IPNG, not >30% calories should be derived from fat and saturated fats avoided.

Children with primary NS are associated with oxidative stress even during remission. The use of antioxidants in the NS appears useful, but large clinical trials to ascertain their effectiveness and safety in nephrotic patients are still lacking.

Children who frequently relapse and are steroid dependent may require long-term dietary advice to monitor and maintain nutritional status and prevent obesity. Growth and endocrine function are important issues in the long-term management of such patients. Prednisolone treatment undoubtedly stimulates the child's appetite, and dietary advice about the prevention of excessive weight gain is important.


  Salt Top


While salt restriction is not necessary for most patients with steroid-sensitive NS, reduction of salt intake (1–2 g per day) is advised for those with persistent edema.






 

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