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 (edema). The diet for a child with nephrotic syndrome may include salt (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 drinks
Ice cream, sherbet, frozen yogurt
Helpful hints for restricting your child's fluid intake
Your child's healthcare provider will discuss with you how much fluid your child should have on a daily basis, based on his or her medical condition. The following recommendations may help with effectively monitoring and restricting your child's fluid intake. Talk to your child's healthcare provider for more 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 (melon, berries, grapes) can help quench thirst.
Chewing gum or hard candy can help to quench thirst.
Have your child rinse his or her mouth with cold water, but 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 or 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 healthcare provider or dietitian will advise you on how much fluid your child may have each day. This amount is usually given in ounces, cups, or cubic centimeters (cc).
1 ounce = 30 cc
1 cup = 8 ounces = 240 cc
1 pint = 2 cups = 16 ounces = 480 cc
1 quart = 4 cups = 32 ounces = 960 cc
1 tablespoon = 1/2 ounce = 15 cc
1 teaspoon = 5 cc
Following a low-sodium diet
A low-sodium or salt-restricted diet may be used to help prevent or reduce fluid retention in your child's body. The amount of sodium allowed in your child's diet depends on your child's medical condition. Your child's healthcare provider or dietitian will determine how much sodium your child can have. This is usually expressed in milligrams (mg) per day. Some common sodium restrictions include 1,500 to 2,000 mg per day. Sodium intake for your child will often be based on his or her weight. With most low-sodium diets, high-sodium foods are limited. Salt is not allowed in food preparation or at the table.
What foods are high in sodium?
The following foods are high in sodium. Your child should not eat them if he or she has been prescribed a low-sodium diet:
Most canned foods (vegetables, meats, pasta meals)
Processed foods (meats, such as bologna, pepperoni, salami, hot dogs, and sausage)
Dried pasta and rice mixes
Most soups (canned and dried)
Snack foods (chips, popcorn, pretzels, cheese puffs, salted nuts)
Dips, sauces, and salad dressings
You can often find low-sodium versions of different foods to use in place of the higher-sodium varieties.
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)
Drinks such as juices, tea, fruit drink or punch, and some 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 don’t need to be restricted:
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:
How to reduce your child's salt intake
The following recommendations may help to decrease the amount of salt in your child's diet:
Don't use salt in cooking or at the table.
Cook with herbs and spices or, if permitted by your child's healthcare provider, use salt substitutes.
Seasonings with the word salt in the name are high in sodium. When seasoning foods, use fresh garlic or garlic powder instead of garlic salt. 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, ask for dressings and sauces on the side for your child. Ask the chef to hold the salt in food preparation.
Type of food
Foods to avoid
Milk, yogurt, cheese
Whole, 2%, or skim milk
Cottage cheese, regular hard cheeses, tofu
Puddings, custards, ice cream
Meat, fish, poultry
Fresh or frozen meats, poultry, fish
Low-sodium canned tuna or salmon
Dried beans and peas
Soybean or vegetable protein
Salted or canned meats, fish (sardines, herring, anchovies), or poultry
Lunch meats (bologna, ham, corned beef)
Cured meats (ham, bacon, sausage)
Hot dogs, dried beef, jerky
Commercially frozen entrees
Starches, breads, cereals
Potatoes, macaroni, spaghetti, noodles, rice
Unsalted potato chips, low-sodium pretzels, unsalted crackers, unsalted popcorn, and nuts
Whole-grain and enriched breads
Pancakes, muffins, French toast, waffles, biscuits, cookies, cakes
Whole-grain and enriched cooked or commercially prepared dry cereals
Potato chips, slated snack foods, or pretzels
Commercially prepared rice and noodle mixes
Salted breads, rolls, and crackers
Salted popcorn and nuts
Chocolate, cocoa, horseradish, herbs and spices such as onion powder, fresh garlic, garlic powder, celery seed
Flavorings such as vinegar, lemon juice, Tabasco
Low-sodium condiments, seasonings, and salt substitutes
Ketchup, chili sauce, barbecue sauce, mustard, gravy (limit to 1 Tbsp per day)
Low-sodium canned soups, homemade soups
Commercially prepared meat sauces
Monosodium glutamate (MSG)
Onion salt, garlic salt, celery salt, seasoned salt
Relish, soy sauce, Worcestershire sauce
Dehydrated soup or bouillon, canned soups
Butter, margarine, lard, shortening, vegetable oil, mayonnaise
Salad dressing (limit 1 Tbsp per day)
Salt pork, bacon fat, fat back
More than 1 Tbsp salad dressing per day
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:
Orange juice (1/2 cup)
Dry cereal (1/2 cup)
Toast (1 slice)
Margarine (1 tsp)
Jelly (1 Tbsp)
Low-fat milk (1 cup)
Beef patty (3 oz)
Hamburger bun (1)
Mustard (1 Tbsp)
Ketchup (1 Tbsp)
Sliced tomato and lettuce
Low-fat milk (1 cup)
Baked, breaded chicken strips, homemade (3 oz)
Oven-baked French fries, homemade (1/2 cup)
Green beans (1/2 cup)
Dinner roll (1)
Margarine (1 tsp)
Apple juice (1 cup)
Frozen yogurt (1/2 cup)
Cereal fruit bar
Oatmeal cookies (2)
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:
The food label reads
What this means
Less than 5 mg sodium per serving
Meets requirements for sodium-free
140 mg sodium or less per serving
Very low sodium
35 mg sodium or less per serving
At least 25% less sodium when compared to the same product without reduced sodium
Light in sodium
50% less sodium per serving when compared to foods with more than 40 calories per serving or more than 3 gm of fat per serving
Unsalted; no added salt; without added salt