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 limits on salt (sodium) and fluids. These limits 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:

  • Milk, water, juice, soda, and other drinks

  • Ice cubes

  • Ice cream, sherbet, and frozen yogurt

  • Ice pops

  • Gelatin

  • Soup

  • Pudding

Helpful hints for limiting how much fluid your child has

Your child's healthcare provider will discuss with you how much fluid your child should have every day, based on their health condition. The following advice may help you to monitor and limit how much fluid your child has. Talk with your child's healthcare provider for more information:

  • Find out how much fluid your child's favorite glass or cup holds so that you don't have to measure the 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.

  • Don't give your child salty foods. 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 quench thirst.

  • Have your child rinse their 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 them 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 can have each day. This amount is usually given in ounces, cups, or cubic centimeters (cc).

1 oz. = 30 cc

1 cup = 8 oz. = 240 cc

1 pint = 2 cups = 16 oz. = 480 cc

1 quart = 4 cups = 32 oz. = 960 cc

1 tablespoon = 1/2 oz. = 15 cc

1 teaspoon = 5 cc

Following a low-sodium diet

A low-sodium or salt-restricted diet can help prevent or reduce how much fluid your child retains. The amount of sodium allowed in your child's diet depends on your child's health condition. Their 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 their weight. With most low-sodium diets, high-sodium foods are limited. Salt is not allowed when you prepare food or at the table.

What foods are high in sodium?

The following foods are high in sodium. Your child should not eat them if they have 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)

  • Cheese

  • 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 limited:

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

  • Salad dressing

  • Steak sauce

How to reduce how much salt your child has

The following advice 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 use a salt substitute, if your child's healthcare provider says it's OK to do so.

  • 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

  • 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, tofu

  • 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, salted 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 limit

In many cases with nephrotic syndrome, your child may be placed on a diet allowing only 3,000 mg of sodium per day. 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 with foods with more than 40 calories per serving or more than 3 grams 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