Gluten-Free Diet in Childhood Difficult-to-Treat Nephrotic Syndrome: A Pilot Feasibility Study
Introduction: Minimal change disease in childhood can follow a frequently relapsing or steroid-dependent course in up to 40% of cases. Second-line immunosuppressive medications that are used to manage these patients are associated with significant adverse effects. There is a need for safer alternati...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Karger Publishers
2022-06-01
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| Series: | Glomerular Diseases |
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| Online Access: | https://www.karger.com/Article/FullText/525587 |
| _version_ | 1828333253396791296 |
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| author | Tarak Srivastava Katherine M. Dell Kevin V. Lemley Debbie S. Gipson Frederick J. Kaskel Kevin Edward Meyers Christian Faul Ayelet Goldhaber LauraJane Pehrson Howard Trachtman |
| author_facet | Tarak Srivastava Katherine M. Dell Kevin V. Lemley Debbie S. Gipson Frederick J. Kaskel Kevin Edward Meyers Christian Faul Ayelet Goldhaber LauraJane Pehrson Howard Trachtman |
| author_sort | Tarak Srivastava |
| collection | DOAJ |
| description | Introduction: Minimal change disease in childhood can follow a frequently relapsing or steroid-dependent course in up to 40% of cases. Second-line immunosuppressive medications that are used to manage these patients are associated with significant adverse effects. There is a need for safer alternative treatments for difficult-to-treat nephrotic syndrome. Therefore, we conducted an open-label feasibility study to assess the safety and efficacy of a gluten-free diet as treatment for pediatric patients with difficult-to-treat nephrotic syndrome. As a second aim, we sought to determine if the plasma zonulin concentration can identify those who are more likely to respond to this intervention. Methods: Seventeen patients were placed on a gluten-free diet for 6 months. A positive response was defined as a 50% reduction in the relapse rate compared to the preceding 6 months or the ability to discontinue 1 immunosuppressive drug. Results: Five (29%) participants had a positive response to the dietary intervention. The gluten-free diet was well tolerated with no clinical or laboratory adverse events. Plasma zonulin concentration was elevated in patients who failed to benefit from the gluten-free diet. Discussion/Conclusion: A gluten-free diet may be a useful adjunctive intervention for patients with difficult-to-treat nephrotic syndrome that can be implemented prior to resorting to second-line immunosuppressive therapy. Development of the plasma zonulin level as a biomarker to predict efficacy would facilitate rational use of a gluten-free diet in the management of nephrotic syndrome. |
| first_indexed | 2024-04-13T21:17:34Z |
| format | Article |
| id | doaj.art-47cf391d09624317bd22d0ca8697b20f |
| institution | Directory Open Access Journal |
| issn | 2673-3633 |
| language | English |
| last_indexed | 2024-04-13T21:17:34Z |
| publishDate | 2022-06-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Glomerular Diseases |
| spelling | doaj.art-47cf391d09624317bd22d0ca8697b20f2022-12-22T02:29:37ZengKarger PublishersGlomerular Diseases2673-36332022-06-011810.1159/000525587525587Gluten-Free Diet in Childhood Difficult-to-Treat Nephrotic Syndrome: A Pilot Feasibility StudyTarak Srivastava0Katherine M. Dell1Kevin V. Lemley2Debbie S. Gipson3https://orcid.org/0000-0003-4473-9045Frederick J. Kaskel4Kevin Edward Meyers5https://orcid.org/0000-0001-6653-269XChristian Faul6https://orcid.org/0000-0002-7512-0977Ayelet Goldhaber7LauraJane Pehrson8https://orcid.org/0000-0002-4612-1751Howard Trachtman9https://orcid.org/0000-0001-7447-9489Children’s Mercy Hospital, Kansas City, MO, USACleveland Clinic-Children’s, Case Western Reserve University, Cleveland, OH, USAChildren’s Hospital Los Angeles, Los Angeles, CA, USAC S Mott Hospital, Ann Arbor, MI, USAChilden’s Hospital at Montefiore, Bronx, NY, USAChildren’s Hospital of Philadelphia, Philadelphia, PA, USAUniversty of Alabama-Birmingham, Birmingham, AL, USAHassenfeld Children’s Hospital, NYU Grossman School of Medicine, New York, NY, USAHassenfeld Children’s Hospital, NYU Grossman School of Medicine, New York, NY, USAHassenfeld Children’s Hospital, NYU Grossman School of Medicine, New York, NY, USAIntroduction: Minimal change disease in childhood can follow a frequently relapsing or steroid-dependent course in up to 40% of cases. Second-line immunosuppressive medications that are used to manage these patients are associated with significant adverse effects. There is a need for safer alternative treatments for difficult-to-treat nephrotic syndrome. Therefore, we conducted an open-label feasibility study to assess the safety and efficacy of a gluten-free diet as treatment for pediatric patients with difficult-to-treat nephrotic syndrome. As a second aim, we sought to determine if the plasma zonulin concentration can identify those who are more likely to respond to this intervention. Methods: Seventeen patients were placed on a gluten-free diet for 6 months. A positive response was defined as a 50% reduction in the relapse rate compared to the preceding 6 months or the ability to discontinue 1 immunosuppressive drug. Results: Five (29%) participants had a positive response to the dietary intervention. The gluten-free diet was well tolerated with no clinical or laboratory adverse events. Plasma zonulin concentration was elevated in patients who failed to benefit from the gluten-free diet. Discussion/Conclusion: A gluten-free diet may be a useful adjunctive intervention for patients with difficult-to-treat nephrotic syndrome that can be implemented prior to resorting to second-line immunosuppressive therapy. Development of the plasma zonulin level as a biomarker to predict efficacy would facilitate rational use of a gluten-free diet in the management of nephrotic syndrome.https://www.karger.com/Article/FullText/525587glomerular diseasenephrotic syndromeproteinuriagluten-free dietpilot studychildhooddifficult-to-treat diseasezonulin |
| spellingShingle | Tarak Srivastava Katherine M. Dell Kevin V. Lemley Debbie S. Gipson Frederick J. Kaskel Kevin Edward Meyers Christian Faul Ayelet Goldhaber LauraJane Pehrson Howard Trachtman Gluten-Free Diet in Childhood Difficult-to-Treat Nephrotic Syndrome: A Pilot Feasibility Study Glomerular Diseases glomerular disease nephrotic syndrome proteinuria gluten-free diet pilot study childhood difficult-to-treat disease zonulin |
| title | Gluten-Free Diet in Childhood Difficult-to-Treat Nephrotic Syndrome: A Pilot Feasibility Study |
| title_full | Gluten-Free Diet in Childhood Difficult-to-Treat Nephrotic Syndrome: A Pilot Feasibility Study |
| title_fullStr | Gluten-Free Diet in Childhood Difficult-to-Treat Nephrotic Syndrome: A Pilot Feasibility Study |
| title_full_unstemmed | Gluten-Free Diet in Childhood Difficult-to-Treat Nephrotic Syndrome: A Pilot Feasibility Study |
| title_short | Gluten-Free Diet in Childhood Difficult-to-Treat Nephrotic Syndrome: A Pilot Feasibility Study |
| title_sort | gluten free diet in childhood difficult to treat nephrotic syndrome a pilot feasibility study |
| topic | glomerular disease nephrotic syndrome proteinuria gluten-free diet pilot study childhood difficult-to-treat disease zonulin |
| url | https://www.karger.com/Article/FullText/525587 |
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