What are the dietary recommendations for patients with nephrotic syndrome?

Dietary Recommendations for Nephrotic Syndrome

Patients with nephrotic syndrome should follow a sodium-restricted diet (<2g/day), moderate protein intake (0.8g/kg/day for non-dialysis patients), and avoid ultra-processed foods to manage edema and slow disease progression. 1, 2

Sodium Restriction

• Limit sodium intake to less than 2g/day (equivalent to <5g sodium chloride/day) 1, 2
• Focus on reducing consumption of processed and restaurant foods, which account for approximately 80% of sodium intake in developed countries 1
• Choose lower-sodium alternatives when purchasing food
• Salt restriction is particularly important for managing resistant hypertension and edema 1

Protein Recommendations

• For adults with nephrotic syndrome not on dialysis: 0.8g/kg body weight/day 2
• For patients on dialysis: 1.0-1.2g/kg body weight/day 2
• Avoid high protein intake (>1.3g/kg/day) as it can accelerate kidney disease progression 2
• Prioritize plant-based protein sources (>50% of total) over animal sources 2
• Protein restriction should be avoided in:
  • Children with nephrotic syndrome 2
  • Metabolically unstable patients 2
  • Older adults with frailty or sarcopenia 2

Fluid Management

• Fluid restriction is recommended for patients with hyponatremia and severe edema 1
• Use concentrated high-calorie formulas when appropriate to limit fluid intake while maintaining nutrition 1
• Assessment of volume status (overfill versus underfill) should guide fluid management 1

Additional Dietary Components

• Energy intake: 25-35 kcal/kg body weight/day based on age, sex, and activity level 2
• Increase consumption of fruits and vegetables to help decrease blood pressure and net acid production 2
• Consider a Mediterranean diet pattern to improve lipid profiles 2
• Monitor potassium levels, especially with increased plant food intake 2

Lifestyle Modifications

• Regular physical activity: at least 150 minutes of moderate-intensity activity per week 1, 2
• Achieve and maintain a healthy weight (BMI 20-25) 1
• Stop smoking 1
• Avoid sedentary behavior 2

Monitoring and Implementation

• Regular assessment by a registered dietitian is essential 2
• Monitor:
  • Body weight changes
  • Biochemical data (albumin, lipids, electrolytes)
  • Nutritional status
  • Edema
  • Blood pressure

Common Pitfalls to Avoid

• Overly restrictive diets that may lead to malnutrition
• Ignoring the need for sodium restriction in patients with significant edema
• Applying the same protein restrictions to all patients regardless of age, metabolic status, or dialysis status
• Failing to consider the patient's ability to adhere to dietary recommendations

Dietary management should be integrated with pharmacological treatment, including angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) for proteinuria reduction, and appropriate management of hyperlipidemia with statins when indicated 1.