Pediatric Oncall- DIET IN NEPHROTIC SYNDROME

DIET IN NEPHROTIC SYNDROME

Nephrotic syndrome occurs when the filters in the kidney leak an excessive amount of protein. The level of protein in the blood then falls and this allows fluid to leak across very small blood vessels into the tissues. Swelling around the eyes, abdomen and legs is a consequence of this process.

The disease is characterised by proteinuria (Excessive protein especially albumin in the urine), low blood protein and oedema(swelling in the tissues). Protein losses in the urine are commonly 5-10gms per day but may also exceed 30gms per day.

Clinical symptoms:

Swelling(oedema)
General
Around the eyes
In the extremities, especially feet and ankles.
Abdomen swollen
Facial swelling
Foamy appearance of the urine
Weight gain(unintentional) from fluid retention
Poor appetite(anorexia)
High blood pressure

Nutritional management:

One of the aims of nutritional management is to replace as much of the protein loss in the urine by a intake of good quality protein. The dietary modification may be as follows:

Protein: A balanced diet adequate in both energy and protein (1-2gms per kilogram body weight) should be adequate for most children. Since Indian children usually have a low intake of protein (even less than the RDA), adequate protein intake – upto 2gm/kg/day in children and not more than 3gm/kg/day in infants is advocated. A very high protein diet may cause tubular damage to the kidneys as the kidneys will have to filter more of the proteins.

Foodstuffs rich in protein are cow’s milk, skimmed milk, eggs, fish, dry fish, chicken, lean meat, paneer made from cow’s milk, cheese, sprouts, pulses and legumes such as tur dal, moong dal, rajmah, chana, lentils (masoor), etc.

Calories: A high calorie diet so as to conserve protein should be necessary. However fat content is not increased in the diet as patients with nephrotic syndrome have high serum trigylcerides.

Sodium: To prevent massive oedema, sodium levels in the diet must be low. Usually 500mg sodium diet is satisfactory. Salt should be restricted but diets should be palatable. Usually added salt is prohibited in these children. Table below indicates some of the foodstuffs high in sodium:

FOODSTUFFS HIGH IN SODIUM

Baking soda

Salt

Ajinomoto

Salted wafers, popcorns, salted biscuits.

Papads – all varieties.

Salted pickles, chutneys, curry powder – commercial.

Commercial salad dressings and sauces.

Soup cubes.

Soft drinks containing sodium benzoate.

Bakery products, bread, biscuits.

Nuts such as salted cashewnuts, pistachio, walnuts, peanuts.

Commercial cheese.

Preservative containing foods.

Canned and tinned foods.

Sea food, chicken, dry fish, bacon, ham .

Meat and yeast extracts like marmite.

Proprietary drinks – Bournvita, chocolate drinks, Horlicks.

Milk and curds.

Pulses and legumes – all varieties.

Vegetables such as – cauliflower , snakegourd , beetroot , carrot , coriander leaves, fenugreek(methi) leaves, lettuce ,spinach (palak) ,amaranth, radish

Fats/oils:It is recommended that as part of the initial general healthy eating advice, oils and saturated fats(ghee, butter, margarine, coconut oil) should be avoided.

A TYPICAL DIET IN NEPHROTIC SYNDROME

Assumption:

Weight of the patient:50kg

Calories: 50cal / kg body weight

Proteins: 2gms / kg body weight

MEAL	MENU
Breakfast 8:00am	1 bowl ragi porridge/oats porridge/rava porridge/sago kheer/vermicelli kheer/cornflakes with milk. + 1 small banana + 2 egg whites/30gms paneer
Midmorning 10:30am	1 Katori sprouts(moong,chana,matki)/ roasted chana.
Lunch 1:00pm	2 chappatis(dry) made from soya flour. 1 katori rice 1 katori vegetable 1 katori dal 1katori curds
Teatime 4:30pm	1 cup milk 1 katori rava upma/poha/2 rasgullas(cows milk)/2 moong or chana dal cheelas(pancakes) made on nonstick/2-3 potato pattice (made on nonstick)
Snacks 6:30pm	1 fruit (apple/banana/chikoo/
Dinner 8:30pm	Same as lunch {Dal could be substituted with fish curry(1 small pc fish),chicken(50gms),paneer (40gms)}
Bedtime 10:00pm	1 glass banana /chickoo milkshake

Serving size: Nutritive value of the above diet

1 katori = 150ml/gms Calories :2500cal

1bowl = 200ml Proteins:100gms

1cup = 150ml

1glass = 200 ml

1 tsp = 5gms/ml

1tbsp = 15gms/ml

Last updated on 23-02-2001

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