How should you eat with nephrotic syndrome?

Written by Zhang Hui
Nephrology
Updated on September 02, 2024
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Nephrotic syndrome is characterized by urine protein greater than 3.5 grams, serum albumin less than 30, the presence of edema, and hyperlipidemia. Patients matching these criteria can be diagnosed with nephrotic syndrome. From its diagnosis, we can see that such patients have a high amount of urine protein and relatively low blood protein. For these patients, it is necessary to control their protein intake, generally suitable at 0.6-0.8 grams per kilogram of body weight per day. Due to hypoalbuminemia, as the liver synthesizes protein, it also leads to an increase in blood lipids. Therefore, patients with nephrotic syndrome need to follow a low-fat diet to avoid further elevation of blood lipids. Additionally, as patients with nephrotic syndrome generally have edema, it is necessary to restrict sodium intake to prevent sodium and water retention, further aggravating the edema.

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Written by Li Liu Sheng
Nephrology
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Conditions for discontinuing medication for nephrotic syndrome

The main clinical manifestations of nephrotic syndrome are significant proteinuria and hypoproteinemia, along with varying degrees of hyperlipidemia and edema. Nephrotic syndrome often requires treatment with corticosteroids. The general principle for using steroids is to start with a sufficient dosage and administer it slowly, maintaining it for a long duration, approximately around one year. Therefore, the conditions for discontinuing medication in nephrotic syndrome include: if the patient has been treated with steroids for about a year, and the proteinuria has resolved, 24-hour urinary protein quantification is normal, there is no edema, blood albumin levels have returned to normal, and kidney function is also normal, then discontinuation of steroid treatment can be considered. Of course, after stopping the medication, it is essential to regularly visit the hospital for monitoring of routine urine tests, kidney function, and blood pressure to prevent the recurrence of nephrotic syndrome due to infections or fatigue.

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Nephrology
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What to do if nephrotic syndrome causes leg pain?

Patients with nephrotic syndrome who experience leg pain mostly have conditions unrelated to nephrotic syndrome itself. It could be due to diseases of the skeletal or muscular system. However, some patients might experience leg pain due to thrombosis caused by nephrotic syndrome, leading to ischemia in the limbs. Also, long-term use of corticosteroids can lead to necrosis of the femoral head, osteoporosis, and pain. Therefore, treatment should be targeted based on the cause, such as using drugs to dissolve clots or interventional surgery for those with thrombosis. In severe cases of femoral head necrosis, a femoral head replacement surgery might be necessary, and it is important to supplement with calcium regularly.

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Written by Zhou Qi
Nephrology
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Is nephrotic syndrome prone to recurrence?

Nephrotic syndrome is characterized by more than 3.5 grams of proteinuria in 24 hours and a serum albumin concentration lower than 30 grams per liter. Treatment of this disease should be aimed at the cause, with most patients suffering from primary nephrotic syndrome related to immune dysfunction, therefore often requiring treatment with steroids. Indeed, some patients easily experience relapses; after a period of steroid treatment, proteinuria may decrease or even turn negative. However, upon cessation of the medication or during occurrences like a cold, some patients may suffer from relapses. Not all patients respond this way, as some are dependent on steroids.

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Written by Li Liu Sheng
Nephrology
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What should I do about the high fever caused by nephrotic syndrome?

Patients with nephrotic syndrome, due to long-term use of steroids, have particularly weak resistance and are prone to various infections. High fever is a common symptom in patients with nephrotic syndrome after an infection. Once a high fever due to infection occurs in nephrotic syndrome, it must be taken seriously because infections are often a significant trigger for the relapse or worsening of the condition. Once the condition worsens, patients often experience heavy proteinuria, hypoalbuminemia, edema, and declining kidney function. Therefore, it is crucial to go to the hospital in a timely manner after the onset of high fever for medical treatment, and to conduct routine blood and urine tests, kidney function tests, and chest X-rays to determine the cause of the patient's high fever, whether it is a viral or bacterial infection. Besides, it is important to drink plenty of water, urinate frequently, rest in bed, reduce outdoor activities, and avoid fatigue. If a viral infection causes the fever, antiviral medications that clear heat and detoxify should be used. If a bacterial infection causes the fever, sensitive antibiotics should be used for symptomatic treatment. (Medications should be used under the guidance of a doctor.)

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What should not be eaten with nephrotic syndrome?

Patients with nephrotic syndrome, if the patient has obvious edema, should limit salt intake to between two to three grams per day. It is suggested to consume foods rich in polyunsaturated fatty acids, such as vegetable oils, as well as foods rich in soluble fiber, such as oats. They should also receive a normal amount of 0.8 to 1 gram of high-quality protein per kilogram of body weight per day, mainly from egg whites, milk, lean meat, and fish. Calorie intake should be sufficient, and patients with nephrotic syndrome should eat less salty and pickled foods and consume less animal fat.