It’s recommended that children with nephrotic syndrome follow dietary guidelines to minimize their symptoms, as well as the side effects from medication. A new study published in spring 2021 in Pediatric Nephrology sheds light on how well children are able meet these nutritional needs along with their intake of supplements – and suggests that special attention is needed to ensure adequate calcium and vitamin D intake in this population.
Like many kidney patients, children with nephrotic syndrome commonly experience fluid retention requiring them to limit both their sodium and fluid intakes. As well, the corticosteroids used to treat nephrotic syndrome can negatively impact bone health. Therefore, calcium and vitamin D supplements are recommended.
In 2007, the Pediatric Nephrology Clinical Pathway Development Team at BC Children’s Hospital created a clinical pathway with a set of guidelines to help children with nephrotic syndrome and their families understand their dietary needs. Once the clinical pathway was implemented, the team was curious to know if children were able to meet the pathway’s diet guidelines.
Nonnie Polderman is a renal dietitian who helped develop the guidelines and co-led the new study. She notes that few studies in the past have explored both dietary intake and supplement use to assess whether nutritional requirements are being met: “As far as we are aware, our study is the first of its kind.”
In their study, the team analyzed the food records of 36 children newly diagnosed with nephrotic syndrome. This involved analyzing intakes of energy, sodium, vitamin D and calcium intake reported by families using a three-day food intake period.
“Based on the results, we learned that our simple, practical approach to teaching families to limit the energy and sodium in their child’s diet appeared to be working well,” says Polderman.
She says feedback from patients and their families was positive and that even parents reported lower blood pressure results thanks to the entire family adopting a healthier diet, lower in sodium. Only four patients out of 36 in the study were found to exceed the pathway’s sodium recommendations by more than 50 percent.
However, a key finding of the study revealed that many of the children were not meeting the recommended daily intakes of calcium or vitamin D. Only one patient in the study had an adequate vitamin D intake and that was due to the use of a daily supplement.
“The potential impact of not receiving adequate calcium and vitamin D for children with nephrotic syndrome is not well understood, but weakened bones and an increased risk of osteoporosis is possible,” says Polderman.
As a result, BC’s Pediatric Nephrology Clinical Pathway Development Team is working to further refine the pathway’s diet guidelines to create more individualized recommendations for calcium and vitamin D.
“This work aims to better meet the needs of patients across the age spectrum seen in our pediatric group,” says Polderman. “By having a standardized pathway that includes nutrition guidelines, the renal dietitians are able to have a positive impact on patients’ care early on in their journey.”