For a patient with nephrotic syndrome presenting with pitting edema, which dietary modification is appropriate?

• A. Increase potassium intake to 4000 mg daily.
• B. Restrict fluids to 1 liter per day.
• C. Limit protein to 0.8 g/kg/day.
• D. Daily dietary sodium restriction of 2 grams.

Answer: (D)

In nephrotic syndrome, losing protein in the urine lowers plasma oncotic pressure, causing fluid to shift into tissues. The body also tends to retain sodium and water to preserve volume, which worsens edema. Therefore, reducing sodium intake helps pull fluid back into the vessels and decreases edema progression. Limiting daily sodium to about 2 grams directly targets this fluid retention and is the appropriate dietary step.

Increasing potassium intake doesn’t address the edema and can be unsafe with kidney issues. Restricting fluids isn’t routinely needed for nephrotic edema and can risk dehydration without solving the underlying fluid overload. Limiting protein to 0.8 g/kg/day would worsen hypoalbuminemia and edema by reducing available oncotic protein.