Patient's question:
My father has been sick for a year and a half. How should I plan his diet? His age is 53, and his condition is currently a bit serious, with his creatinine level rising to around 500. Last year, he received treatment at West China Hospital for two months, and he needs to undergo monthly check-ups at a major hospital. How should he be fed?Doctor's answer:
Clinical manifestations of nephrotic syndrome include massive proteinuria, hypoproteinemia, hyperlipidemia, and severe edema. Dietary management is crucial.(1) Salt restriction: The amount of salt restriction should be determined based on the degree of edema. Patients with severe edema should avoid salt. Those with reduced but persistent edema should follow a low-salt diet (approximately 3 grams of salt per day). Once the edema subsides and plasma protein levels return to near-normal, a regular diet can be resumed.
(2) Protein intake: Nephrotic syndrome leads to significant protein loss, and hypoproteinemia often results in decreased colloid osmotic pressure, making edema difficult to resolve and weakening the body's resistance. Under the absence of renal dysfunction or lipid failure, it is recommended to ensure an adult's daily protein intake of approximately 90–100 grams, which generally helps maintain positive nitrogen balance. If appetite is poor and intake is insufficient, start with 1 gram per kilogram of body weight per day, supplemented with traditional Chinese medicine to regulate spleen and stomach function and diuretics to reduce gastrointestinal edema. Gradually increase protein intake to 1.5 grams per kilogram per day as appetite improves. Once the patient's appetite returns to normal, free feeding is allowed. After plasma protein levels rise to near-normal or edema resolves, a regular diet can be adopted.
(3) Fat: Patients with nephrotic syndrome often have hyperlipidemia. In mild cases, where the condition improves rapidly, fat intake is not restricted. However, for refractory nephrotic syndromes such as membranous nephropathy, long-term hyperlipidemia can lead to atherosclerosis. Therefore, fatty meats and foods rich in animal fat should be limited.
(4) Intake of vitamins, calcium, and trace elements: In nephrotic syndrome, increased permeability of the glomerular basement membrane leads to the loss of not only albumin but also certain elements and hormones bound to proteins. This indirectly causes deficiencies in calcium, magnesium, zinc, etc. These can be replenished through medication or dietary sources.