Manual of Clinical Nutrition

Nephrotic Syndrome

Manual of Clinical Nutrition Management III- 80 Copyright © 2013 Compass Group, Inc.

Approaches (2,3) Rationale

Vitamins and minerals:

Base intake on food and nutrition

assessment and biochemical levels:

 Provide iron, based on the

individual patient’s need (2).

 Ensure patient is meeting Dietary

Reference Intakes for B-complex

vitamins (niacin, riboflavin, and

thiamin) and vitamin C.

Supplement as needed (2).

 Supplement 1 to 1.5 g of calcium,

not to exceed 2,000 mg (2).

 Limit phosphorus to <12 mg/kg per

day (6).

Abnormalities in iron, copper, zinc, and calcium levels are directly

related to the urinary loss of proteins that are involved in their

metabolism (2,3). For example, the increased loss of transferrin

causes decreased plasma iron levels. Iron supplementation is

important for patients who have nephrotic syndrome (3). Copper is

also bound to protein, and serum copper levels are often

compromised. However, clinical manifestations do not occur as a

result of the low copper levels; therefore, supplementation is not

necessary (3). Supplemental zinc may be needed, as zinc is bound to

albumin (3). In addition, decreased levels of calcium and serum 1,25-

dihydroxycholecalciferol may occur as a result of being bound to

albumin (3). Supplemental calcium, vitamin D, and iron may be

needed to normalize serum levels.

References

1. Madaio M, Harrington J. The diagnosis of glomerular diseases: acute glomerulonephritis and nephrotic syndrome. Arch Intern
   Med. 2001;161:25-34.


2. Nephrotic syndrome. In: Nutrition Care Manual. Academy of Nutrition and Dietetics; Updated annually. Available at:
   http://www.nutritioncaremanual.org. Accessed January 12, 2013.


3. Kopple JD, Massry SG, eds. Nutrition Management of Renal Disease. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004.


4. D'Amico G, Gentile MG, Manna G, Fellin G, Ciceri R, Cofano F, Petrini C, Lavarda F, Perolini S, Porrini M. Effect of vegetarian soy diet on
   hyperlipidaemia in nephrotic syndrome. Lancet. 1992;339:1131-1134.


5. Giordano M, De Feo P, Lucidi P, DePascale E, Giordano D, Cirillo D, Dardo G, Signorelli SS, Castellino P. Effects of dietary protein restriction
   on fibrinogen and albumin metabolism in nephrotic patients. Kidney Int. 2001;60:235-242.


6. McCann L, ed. Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease. 3rd ed. New York, NY: National Kidney
   Foundation Council on Renal Nutrition; 2002.