Dietary Restrictions for Patients With Nephrotic Syndrome

“What should I eat?” And “Should I avoid protein since I’m losing it in my urine?”

These are questions that I often hear my patients with nephrotic syndrome ask. So today I decided to do a quick review to answer those questions in the clinic and on the wards.

Sodium

Sodium restriction has been shown to enhance the anti-proteinuric effects of RAS blockade (Pubmed). Sodium restriction alone has been shown to decrease proteinuira by 22% according to one prospective double-blinded RCT (Pubmed)

Answer: 2 grams (although the studied used 1.2g)

Protein

Dietary protein restriction has been associated with reduced proteinuria (15% to 25%), but never been shown to induce complete remission. Also protein restriction, unlike sodium restriction, has NOT been proven to add to the anti-proteinuric effects of RAS blockade.

Answer: Dietary protein intake should be restricted to 0.8 g/kg plus and additional protein gram for gram to match urinary losses. (This is extrapolated in a subgroup analyses from the MDRD study, here is paper on the secondary analyses.)

This is just some quick information you can give your patients to answer their dietary answers.

Source: 4th Edition of Comprehensive Clinical Nephrology

-Adrian