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Polderman N, Cushing M, McFadyen K, et al. Dietary intakes of children with nephrotic syndrome. Pediatr Nephrol. 2021;36(9):2819-2826doi: 10.1007/s00467-021-05055-2.
Polderman, N., Cushing, M., McFadyen, K., Catapang, M., Humphreys, R., Mammen, C., Matsell, D. G. (2021). Dietary intakes of children with nephrotic syndrome. Pediatric nephrology (Berlin, Germany), 36(9), 2819-2826. https://doi.org/10.1007/s00467-021-05055-2
Polderman, Nonnie, et al. "Dietary intakes of children with nephrotic syndrome." Pediatric nephrology (Berlin, Germany) vol. 36,9 (2021): 2819-2826. doi: https://doi.org/10.1007/s00467-021-05055-2
Polderman N, Cushing M, McFadyen K, Catapang M, Humphreys R, Mammen C, Matsell DG. Dietary intakes of children with nephrotic syndrome. Pediatr Nephrol. 2021 Sep;36(9):2819-2826. doi: 10.1007/s00467-021-05055-2. Epub 2021 Mar 30. PMID: 33783623.
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Pediatr Nephrol. 2021 Sep;36(9):2819-2826. doi: 10.1007/s00467-021-05055-2. Epub 2021 Mar 30.

Dietary intakes of children with nephrotic syndrome.

Pediatric nephrology (Berlin, Germany)

Nonnie Polderman, Meredith Cushing, Kirsten McFadyen, Marisa Catapang, Robert Humphreys, Cherry Mammen, Douglas G Matsell,

Affiliations

  1. Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada. [email protected].
  2. British Columbia Children's Hospital, 4480 Oak Street, Room K4-169, Vancouver, BC, V6H 2V2, Canada. [email protected].
  3. Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.

PMID: 33783623 DOI: 10.1007/s00467-021-05055-2

Abstract

BACKGROUND: Our multidisciplinary clinical pathway for treatment of childhood nephrotic syndrome (NS) was established with the goal of standardizing local clinical practice. This descriptive study aimed to assess nutrient intakes of children with newly diagnosed NS compared with nutrition goals defined by our pathway.

METHODS: Our pathway includes evidence-based recommendations that target daily intakes during corticosteroid induction therapy: energy (Estimated Energy Requirements (EER) × Sedentary Physical Activity (PA)), sodium (1 mg/kcal), calcium (Dietary Reference Intake (DRI) + 500 mg elemental calcium), and vitamin D (DRI +800-1000 IU). After dietitian-led education at initial diagnosis, 3-day food records were completed at 4 weeks post-diagnosis. Daily nutrient intakes were compared to pathway targets and DRIs.

RESULTS: Thirty-six children (median age 4.8 years, 44% female) with newly diagnosed NS submitted food records. Mean energy and sodium intakes were 103±22% and 99±53% of pathway targets, respectively. Fourteen (39%) children exceeded pathway sodium recommendations, with four (11%) exceeding them by greater than 50%. Seven (19%) children met DRI for calcium, while six (17 %) met pathway targets for calcium. No children met DRI for vitamin D from diet alone; and only one met the target with supplementation.

CONCLUSIONS: This is the first study to describe dietary intakes of children with newly diagnosed NS. Our clinical pathway targets for energy and sodium were achievable; however, calcium and vitamin D intakes fell short of pathway guidelines and DRIs. Prescription of supplemental calcium and vitamin D may be needed to achieve target intakes of calcium and vitamin D.

© 2021. IPNA.

Keywords: Calcium; Childhood nephrotic syndrome; Energy; Nutrition; Sodium; Vitamin D

References

  1. Downie ML, Gallibois C, Parekh RS, Noone DG (2017) Nephrotic syndrome in infants and children: pathophysiology and management. Paediatr Int Child Health 37:248–258 - PubMed
  2. Eddy AA, Symons JM (2003) Nephrotic syndrome in childhood. Lancet 362:629–639 - PubMed
  3. http://www.bcchildrens.ca/renal-program-site/Documents/NephroticSyndromeParent%27sHandbook.pdf . Accessed 6 Apr 2019 - PubMed
  4. Duffy M, Jain S, Harrell N, Kothari N, Reddi A (2015) Albumin and furosemide combination for management of edema in nephrotic syndrome: a review of clinical studies. Cells 4:622–630 - PubMed
  5. Lui D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn D, Leigh R, Brown J, Cohen A, Kim H (2013) A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, Asthma Clin Immunol 9:30 - PubMed
  6. Homik J, Suarez-Almazor M, Shea B, Cranney A, Wells G, Tugwell P (1998) Calcium and vitamin D for corticosteroid-induced osteoporosis. Cochrane Database Syst Rev 1998(2):CD000952 - PubMed
  7. Devoeglaer J, Goemaere S, Boonen S, Body J, Daufman J, Boutsen Y (2006) Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int 17:8–19 - PubMed
  8. Choudhary S, Agarawal I, Seshadri MS (2014) Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids: a prospective, randomized, controlled, interventional study. Pediatr Nephrol 29:1025–1032 - PubMed
  9. http://www.canada.ca/en/health-canada/services/nutrients/sodium/sodium-basics.html#a1 . Accessed 4 Oct 2013 - PubMed
  10. https://www.nap.edu/read/10925/chapter/1 . Accessed 13 Oct 2012 - PubMed
  11. https://www.nationalacademies.org/news/2019/03/sodium-and-potassium-dietary-reference-intake-values-updated-in-new-report . Accessed 6 Apr 2019 - PubMed
  12. http://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating . Accessed 6 Apr 2019 - PubMed
  13. Ross AC, Taylor CL, Yaktine AL, Del Valle HB (eds) (2011) Dietary Reference Intakes for Calcium and Vitamin D, Washington (DC) - PubMed
  14. Yang J, Lynch KF, Uusitalo UM, Foterek K, Hummel S, Silvis K, Aronsson CA, Riikonen A, Rewers M, She JX, Ziegler AG, Simell OG, Toppari J, Hagopian WA, Lernmark A, Akolkar B, Krischer JP, Norris JM, Virtanen SM, Johnson SB, TEDDY Study Group (2016) Factors associated with longitudinal food record compliance in a paediatric cohort study. Public Health Nutr 19:804–813 - PubMed
  15. McPherson S, Hoelscher D, Alexander M, Scanlon K, Serdula M (2000) Dietary assessment methods among school-aged children: validity and reliability. Prev Med 31:S11–S33 - PubMed
  16. Shatat IF, Becton LJ, Woroniecki RP (2019) Hypertension in childhood nephrotic syndrome. Front Pediatr 7:287 - PubMed
  17. Doucet A, Favre G, Deschenes G (2007) Molecular mechanism of edema formation in nephrotic syndrome: therapeutic implications. Pediatr Nephrol 22:1983–1990 - PubMed
  18. Vegter S, Perna A, Postma MJ, Navis G, Remuzzi G, Ruggenenti P (2012) Sodium intake, ACE inhibition, and progression to ESRD. J Am Soc Nephrol 23:165–173 - PubMed
  19. Charlesworth JA, Gracey DM, Pussell BA (2008) Adult nephrotic syndrome: non-specific strategies for treatment. Nephrology (Carlton) 13:45–50 - PubMed
  20. Hull RP, Goldsmith DJ (2008) Nephrotic syndrome in adults. BMJ 336:1185–1189 - PubMed
  21. Kodner C (2016) Diagnosis and management of nephrotic syndrome in adults. Am Fam Physician 93:479–485 - PubMed
  22. Kapur G, Valentini RP, Imam AA, Mattoo TK (2009) Treatment of severe edema in children with nephrotic syndrome with diuretics alone--a prospective study. Clin J Am Soc Nephrol 4:907–913 - PubMed
  23. Bagga A (2008) Revised guidelines for management of steroid-sensitive nephrotic syndrome. Indian J Nephrol 18:31–39 - PubMed
  24. Watson AR, Coleman JE (1993) Dietary management in nephrotic syndrome. Arch Dis Child 69:179–180 - PubMed
  25. Selewski DT, Chen A, Shatat IF, Pais P, Greenbaum LA, Geier P, Nelson RD, Kiessling SG, Brophy PD, Quiroga A, Seifert ME, Straatmann CE, Mahan JD, Ferris ME, Troost JP, Gipson DS (2016) Vitamin D in incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study. Pediatr Nephrol 31:465–472 - PubMed
  26. Banerjee S, Basu S, Akhtar S, Sinha R, Sen A, Sengupta J (2020) Free vitamin D levels in steroid-sensitive nephrotic syndrome and healthy controls. Pediatr Nephrol 35:447–454 - PubMed
  27. Nielsen CA, Jensen JE, Cortes D (2015) Vitamin D status is insufficient in the majority of children at diagnosis of nephrotic syndrome. Dan Med J 62:A5017 - PubMed
  28. Bak M, Serdaroglu E, Guclu R (2006) Prophylactic calcium and vitamin D treatments in steroid-treated children with nephrotic syndrome. Pediatr Nephrol 21:350–354 - PubMed
  29. Panczyk-Tomaszewska M, Adamczuk D, Kisiel A, Skrzypczyk P, Przedlacki J, Gorska E, Stelmaszczyk-Emmel A, Demkow U, Roszkowska-Blaim M (2015) Markers of bone metabolism in children with nephrotic syndrome treated with corticosteroids. Adv Exp Med Biol 840:21–28 - PubMed
  30. El-Mashad GM, El-Hawy MA, El-Hefnawy SM, Mohamed SM (2017) Bone mineral density in children with idiopathic nephrotic syndrome. J Pediatr 93:142–147 - PubMed
  31. Singh DN, Krishnamurthy S, Kamalanathan SK, Harichandrakumar KT, Sivamurukan P (2018) Three-monthly bolus vitamin D supplements (1000 vs 400 IU/day) for prevention of bone loss in children with difficult-to-treat nephrotic syndrome: a randomised clinical trial. Paediatr Int Child Health 38:251–260 - PubMed
  32. https://www.canada.ca/en/health-canada/services/food-nutrition/food-nutrition-surveillance/health-nutrition-surveys/canadian-community-health-survey-cchs/canadian-children-meet-their-nutrient-requirements-through-food-intake-alone-health-canada-2012.html Accessed 14 Apr 2019 - PubMed
  33. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6452a1.htm . Accessed 14 Oct 2013 - PubMed
  34. https://www.canada.ca/en/health-canada/services/publications/food-nutrition/sodium-intake-canadians-2017.html . Accessed 14 Apr 2019 - PubMed
  35. Sibley M, Roshan A, Alshami A, Catapang M, Jobsis JJ, Kwok T, Polderman N, Sibley J, Matsell DG, Mammen C, Pediatric Nephrology Clinical Pathway Development Team (2018) Induction prednisone dosing for childhood nephrotic syndrome: how low should we go? Pediatr Nephrol 33:1539–1545 - PubMed
  36. Dror DK, Allen LH (2014) Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev 72:68–81 - PubMed
  37. Green BP, Turner L, Stevenson E, Rumbold PL (2015) Short communication: patterns of dairy consumption in free-living children and adolescents. J Dairy Sci 98:3701–3705 - PubMed

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