NEPHROTIC SYNDROME - DIET
Jesal Shah*
Consultant Dietician, Mumbai*
Nephrotic syndrome occurs when filters in 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 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 (1-2gm 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 - up to 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 triglycerides.

- 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 cashew nuts, 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, snake gourd, 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: 2gm/kg body weight
MEAL MENU
Breakfast 
8:00am
1 bowl ragi porridge/oats porridge/rava porridge/sago kheer/vermicelli kheer/corn flakes 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 
1 katori 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 non-stick)
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


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