Nutrition and nephrotic syndrome

Nutritional requirements for a child with nephrotic syndrome

Children with nephrotic syndrome may have trouble regulating their body's water balance. This can cause fluid retention (also known as edema). The diet for a child with nephrotic syndrome may include a sodium and fluid restriction. These restrictions in the diet may help to regulate your child's fluid balance. Any food that is liquid at room temperature counts as a fluid. This includes the following:

• Milk, water, juice, soda, and other beverages
• Ice cubes
• Ice cream, sherbet, frozen yogurt
• Popsicles
• Gelatin
• Soup
• Pudding

Helpful hints for restricting your child's fluid intake

Your child's physician will discuss with you how much fluid your child should consume on a daily basis, based on his/her medical condition. The following recommendations may help with effectively monitoring and restricting your child's fluid intake. Consult your child's physician for additional information.

• Identify the amount of fluid your child's favorite glass or cup holds, so that you do not have to measure your fluids every time. Try using small glasses. Small amounts of fluid in a big glass look like less than small amounts of fluid in a small glass.
• Keep track of how much fluid your child drinks each day; record amounts on a chart by the refrigerator, or another convenient place.
• Avoid salty foods, as they increase thirst
• Iced tea and lemonade quench thirst better than soda
• Frozen pieces of fruit (i.e., melon, berries, grapes) can help quench thirst
• Chewing gum or hard candy can help to quench thirst
• Have your child rinse his/her mouth with cold water, but do not swallow
• Sucking on a lemon wedge can stimulate saliva and moisten the mouth
• Splashing cold water on your child's face and body can help him/her cool off
• Staying out of the sun can help keep your child from becoming thirsty on a hot day

Helpful fluid conversions

Your child's physician or dietitian will advise you on how much fluid your child may have each day. This amount is usually given in ounces, cups, or cc.

• 1 ounce = 30cc
• 1 cup = 8 ounces = 240cc
• 1 pint = 2 cups = 16 ounces = 480cc
• 1 quart = 4 cups = 32 ounces = 960cc
• 1 tablespoon = 1/2 ounce = 15cc
• 1 teaspoon = 5cc

Following a low-sodium diet

A low-sodium diet or salt restriction may be used to help prevent or reduce fluid retention in your child's body. The amount of sodium or salt allowed in your child's diet depends on your child's medical condition. Your child's physician or dietitian will determine the amount of sodium allowed in your child's diet. This is usually expressed in milligrams (mg) per day. Some common sodium restrictions include 2,000, 3,000, or 4,000 mg per day. With most sodium-restricted diets, high-sodium foods are limited and salt is not allowed in food preparation or at the table.

What foods are high in sodium?

The following foods are high in sodium and should be avoided if your child has been prescribed a low-sodium diet:

• Canned foods (vegetables, meats, pasta meals)
• Processed foods (meats such as bologna, pepperoni, salami, hot dogs, sausage)
• Cheese
• Dried pasta and rice mixes
• Soups (canned and dried)
• Snack foods (chips, popcorn, pretzels, cheese puffs, salted nuts, etc.)
• Dips, sauces, and salad dressings

What foods are low in sodium?

• Plain breads, cereals, rice, and pasta (not dried pasta or rice mixes)
• Vegetables and fruits (fresh or frozen)
• Meats (fresh cuts; not processed meats)
• Milk and yogurt (these tend to be moderate in sodium)
• Beverages such as juices, tea, fruit drink/punch, and soda (sports drinks have sodium so these may need to be limited)

What are low-sodium seasonings?

The following are considered low-sodium seasonings and do not require restriction:

What seasonings are high in sodium?

The following seasonings are high in sodium, but may be used in limited amounts, in most cases.

Limit the following seasonings to 1 tablespoon per meal:

• barbecue sauce
• cocktail sauce
• ketchup
• mustard
• hot sauce
• low-calorie salad dressing
• steak sauce

How can I help my child to reduce his/her salt intake?

The following recommendations may help to decrease the amount of salt in your child's diet:

• Do not use salt in cooking or at the table
• Cook with herbs and spices or, if permitted by your child's physician, use salt substitutes such as Mrs. Dash®, NuSalt®, NoSalt®, or Morton's Lite Salt®
• Seasonings with "salt" in the name, such as garlic salt, are high in sodium. When seasoning foods, use fresh garlic or garlic powder, use onion powder instead of onion salt, and try celery seed rather that celery salt.
• Eat home-prepared meals, using fresh ingredients, instead of canned, frozen, or packaged meals. When dining out, request dressings and sauces on the side for your child. Ask the chef to hold the salt in food preparation.

Sample plan for 3,000 mg sodium restriction

In many cases with nephrotic syndrome, your child may be placed on a 3,000 mg per day sodium-restricted diet. If this is the case, the following meal plan has been designed as an example to meet this restriction:

Definitions for sodium claims on food labels:

As you prepare foods for your child, it is important to read food labels carefully. Consider the following: