Ineffectiveness of dietary protein augmentation in the management of the nephrotic syndrome

Abstract

The nephrotic syndrome is a consequence of altered permselectivity of the glomerular basement membrane resulting in urinary losses of albumin and other serum proteins. Although dietary protein augmentation increases albumin synthesis, it has not been shown to increase serum albumin or muscle protein. Dietary protein was increased from 8.5% to 21% in pair-fed rats with Heymann nephritis and resulted in an increase both in albumin synthesis and urinary albumin excretion, but not in serum albumin concentration or in total albumin pools. The increase in dietary protein was 8 times greater than the resulting increase in urinary protein excretion, but nearly all of the additional ingested protein was catabolized to urea and excreted in the urine rather than used to augment growth. Dietary supplementation with protein has no obvious beneficial effect on nutritional status of nephrotic rats.

Utility of muscle ultrasound in nutritional assessment of children with nephrotic syndrome

“…In adult studies, a low-protein diet has been shown to help reduce proteinuria [ 19 , 43 ]. However, in order to ensure proper growth and development in most children and to prevent or treat PEW, increased protein intake closer to 0.8 g/kg/d may be required [ 44 , 45 ]. Therefore, a balance should exist between cardiovascular/psychological outcomes, risks of being overweight and obesity, and appropriate energy and protein intake [ 46 ].…”

Nutritional and Non-nutritional Management of the Nephrotic Syndrome

“…In contrast, none of the increase in weight of nephrotic rats fed 40% protein is found in muscle, but instead is in viscera, namely liver and kidney [45]. Most of the increased protein nitrogen consumed when high protein diets are fed to these animals is excreted in the urine as urea [62,97].…”

Pediatric Nephrotic Syndrome: Pharmacologic and Nutrition Management

“…9 Furthermore, a study in rats that compared dietary protein intakes (8.5% vs 21% of total calories) did not demonstrate an effect on serum albumin concentrations. 11 Once edema has resolved, maintenance fluid requirements can be provided. Children should follow a healthy, age-appropriate diet to meet energy requirements and the daily recommended intake for protein.…”

“…However, this practice is not recommended owing to the concern that high‐protein diets may accelerate glomerulonephritis 9 . Furthermore, a study in rats that compared dietary protein intakes (8.5% vs 21% of total calories) did not demonstrate an effect on serum albumin concentrations 11 . Once edema has resolved, maintenance fluid requirements can be provided.…”