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 cubes

• Ice cream, sherbet, frozen yogurt

• Popsicles

• Gelatin

• Soup

• Pudding

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 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 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 2,000, 3,000, or 4,000 mg per day. 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. They 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)

• 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)

• Drinks such as juices, tea, fruit drink or 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 don’t need to be restricted:

Allspice Bay leaf Basil Chili powder Chives Cinnamon Cloves Curry powder Dill Extracts (vanilla) Vinegar

Garlic (fresh) Garlic powder Ginger Horseradish sauce Lemon juice Lime juice Mace Marjoram Dry mustard Nutmeg

Onion (fresh) Onion powder Oregano Paprika Pepper Rosemary Sage Salt substitutes Tarragon Thyme Tabasco

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 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	Allowed	Foods to avoid
Milk, yogurt, cheese	Whole, 2%, or skim milk Cottage cheese, regular hard cheeses, tofu Puddings, custards, ice cream	Processed cheese, cheese spreads
Meat, fish, poultry	Fresh or frozen meats, poultry, fish Low-sodium canned tuna or salmon Dried beans and peas Soybean or vegetable protein Peanut butter	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 Kosher-prepared meats
Fruits	Fresh, frozen, or canned fruits, fruit juices	None
Vegetables	Fresh, frozen, or low-sodium canned vegetables	Sauerkraut, salted or pickled vegetables Vegetables cooked with salted meats Regular vegetable juices
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
Miscellaneous	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 Olives, pickles Relish, soy sauce, Worcestershire sauce Dehydrated soup or bouillon, canned soups
Fats	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:

Breakfast	Lunch	Dinner
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)
Morning snack	Afternoon snack
Banana Cereal fruit bar	Oatmeal cookies (2) Lemonade

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
Sodium-free	Less than 5 mg sodium per serving
Salt-free	Meets requirements for sodium-free
Low sodium	140 mg sodium or less per serving
Very low sodium	35 mg sodium or less per serving
Reduced sodium	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	No salt is added during processing The product it resembles and substitutes for is normally processed with salt