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Diet for Nephrotic Syndrome

A well-planned diet can replace lost protein and ensure efficient utilization of ingested proteins through provision of adequate calories. Dietary changes can also help control hypertension, edema, and hyperlipidemia, and slow the progression of renal disease.

Protein: High-protein diets are not recommended as they may encourage damage to the nephrons, leading to a progression of renal insufficiency. Since albumin losses in nephrotic patients are due to increased catabolism, rather than a reduction in protein synthesis, low-protein diets, which decrease catabolism, may be more beneficial.2

The optimal amount of dietary protein necessary to prevent protein catabolism and progression of renal disease has not been established. A common recommendation is 0.6 grams of protein per kilogram of ideal body weight, adjusted depending on the glomerular filtration rate and nutritional status, plus gram-for-gram replacement of urinary protein losses.

A vegetarian diet, often used for lipid-lowering, also offers a convenient way to provide adequate, but not excessive, protein. In a 1992 study, a group of 20 nephrotic syndrome patients were put on a vegetarian diet for eight weeks. Protein intake averaged 0.7 grams per kilogram per day, which was more appropriate to their needs than the 1.15 grams per kilogram provided in their usual diet.3

Sodium and Fluid: A limit on sodium of 1-3 grams per day is usually recommended to control edema and hypertension. Diuretics may also be used. A fluid restriction is not warranted unless renal failure occurs.

Lipids: A diet low in saturated fat and cholesterol, combined with loss of excess weight, is recommended to reduce the risk of cardiovascular disease. Many clinicians recommend limiting cholesterol to less than 300 milligrams per day and fat intake to 30 percent of calories. However, research has shown that such recommendations lead to only minimal lipid lowering. As noted in detail in Section 1, low-fat vegetarian diets are much more effective for lipid control and usually lead to the reversal of atherosclerotic disease. Cholesterol-lowering drugs can be used adjunctively if needed.

An eight-week trial in 13 men and 7 women with hyperlipidemia and nephrotic syndrome showed that a vegetarian diet significantly reduced cholesterol, triglycerides, and phosphorus.3

Energy: Calorie intake should be adequate to achieve and maintain ideal body weight and maintain protein stores. Foods rich in complex carbohydrates should provide the majority of calories.

Supplements: Patients with nephrotic syndrome are often low in B vitamins and zinc, and can benefit from supplements. In addition, since a significant portion of serum calcium is protein-bound, it tends to be low when serum proteins are reduced. No modification is routinely needed for potassium, but potassium losses due to secondary hyperaldosteronism may require replacement.4

The following clinical values should be monitored:4

Serum albumin and total protein
Urinary protein
Glomerular filtration rate
Dietary protein, fat, and cholesterol
Daily weights
Serum lipids

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We began this archive as a means of assisting our visitors in answering many of their health and diet questions, and in encouraging them to take a pro-active part in their own health. We believe the articles and information contained herein are true, but are not presenting them as advice. We, personally, have found that a whole food vegan diet has helped our own health, and simply wish to share with others the things we have found. Each of us must make our own decisions, for it's our own body. If you have a health problem, see your own physician.