Nutrition and the Nephrotic Syndrome in Adults

Abstract

Considerable proteinuria, hypoalbumminemia, and edema are the main features of the nephrotic syndrome; other characteristic findings are described in outline. Methods for assessing the nutritional status of a typical nephrotic patient are discussed. Subcutaneous fat is present in normal amounts, but considerable deficit of body protein can be proved by nitrogen balance studies. Protein deficits can be roughly assessed after loss of edema by clinical examination and from body weight, if height, age, and subcutaneous fat measurements are taken into account. Restriction of dietary sodium is useful in delaying the extension of edema. Free intakes of water and other salts are advised. Special consideration is given both to protein and to calorie consumption. After examining evidence from published balance data, high intakes (e.g., 2.0–2.5 g protein and 45–50 calories/kg/day) are found beneficial and necessary for long periods. Such diets are made practicable by inclusion of large supplements of “salt-free” milk. Since treatment with the cortisone group of drugs is becoming widespread, the optimal diet to accompany it requires investigation. Current experience suggests that high protein, high calcium diets are still required, but that in convalescence there should be a progressive fall in calories, possibly best effected by reducing fat intake.