The Effect of a Gluten-Free Diet in Children With Difficult-to-Manage Nephrotic Syndrome

Abstract

Case reports have linked childhood nephrotic syndrome to food sensitivity, including gluten. We report our experience with 8 children (6 boys, 2 girls; age at implementation of special diet 2–14 years) with difficult-to-manage nephrotic syndrome who were placed on a gluten-free diet for 3.4 ± 4.3 years (range, 0.6–14 years) and who had clinical improvement enabling reduction or discontinuation in steroid dosage.

Effect of Combined Gluten-Free, Dairy-Free Diet in Children With Steroid-Resistant Nephrotic Syndrome: An Open Pilot Trial

“…Second, the duration of intervention might not be long enough. Although most patients with SRNS that responded to a dietary intervention showed a quick reduction in proteinuria in the literature, 17 , 18 , 19 only 4 weeks might be too short a period in which to see a significant decrease in proteinuria. Furthermore, the intervention introduces 2 restrictions at the same time (gluten and dairy), so we will not be able to conclude whether a possible proteinuria reduction is caused by which change.…”

“… 16 , 17 In particular, gluten and dairy restrictions have been associated with a significant decrease in proteinuria, both in SSNS/SDNS and in SRNS. 18 , 19 , 20 , 21 In 1977, Sandberg et al. 20 studied 6 children with INS and demonstrated significant reduction in proteinuria (<0.5 g/d) after the removal of cow’s milk from the diet, with exacerbation of proteinuria once patients were rechallenged with cow’s milk.…”

“…More recently, Lemley et al. 19 reported a case series of 8 children (2−14 years of age) with difficult-to-manage INS who were started on gluten-free diet. All patients experienced a significant reduction in the relapse rate, enabling lower doses or withdrawal of steroids or immunosuppressive drugs.…”

“…Different from food allergy that is mediated by an IgE response, food sensitivity is linked to immune cellular dysfunction and is difficult to diagnose, as no circulating antibodies or skin tests have shown a reliable correlation. 17 , 18 , 19 , 21 , 23 , 24 Exposure to sensitive foods may trigger the release of inflammatory factors/cytokines that could directly damage the podocytes ( Figure 2 ). 19 This effect could be mediated in part by contributions from the microbiota.…”

“… 17 , 18 , 19 , 21 , 23 , 24 Exposure to sensitive foods may trigger the release of inflammatory factors/cytokines that could directly damage the podocytes ( Figure 2 ). 19 This effect could be mediated in part by contributions from the microbiota. 25 It has also been hypothesized that gluten-sensitive patients experience an increase in the secretion of a molecule called zonulin, a major modulator of intercellular tight junctions.…”