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Introduction: Steroid-resistant nephrotic syndrome (SRNS) affects both children and adults and has a high rate of progression to end-stage renal disease. Although a subset of patients have well-characterized genetic mutation(s), in the majority of cases, the etiology is unknown. Over the past 50 years, a number of case reports have suggested the potential impact of dietary changes in controlling primary nephrotic syndrome, especially gluten and dairy restrictions. Methods: We have designed a prospective, open-label, nonrandomized, pilot clinical trial, to study the effect of a gluten-free and dairy-free (GF/DF) diet in children with SRNS. The study will be organized as a 4-week summer camp to implement a GF/DF diet in a tightly controlled and monitored setting. Blood, urine, and stool samples will be collected at different time points during the study. Results: The primary end point is a reduction of more than 50% in the urine protein:creatinine ratio. The secondary end points include changes in urine protein, kidney function, and serum albumin, as well as effects in immune activation, kidney injury biomarkers, and gut microbiome composition and function (metagenomic/metatranscriptomic). Conclusion: This study will advance the field by testing the effect of dietary changes in patients with SRNS in a highly controlled camp environment. In addition, we hope the results will help to identify a responder profile that may guide the design of a larger trial for further investigation. Keywords: dairy-free, diet, gluten-free, pediatric summer camp, proteinuria, steroid-resistant nephrotic syndrome

For the majority of patients diagnosed with celiac disease, once a gluten-free diet is initiated, symptoms improve within weeks and may completely resolve in months. However, up to 30% of patients may show signs, symptoms or persistent small intestinal damage after one year on a gluten-free diet. These patients require evaluation for other common GI etiologies and assessment of their celiac disease status in order to make a diagnosis and suggest treatment. Here, we propose an approach to evaluating patients with celiac disease with persistent symptoms, persistently elevated serology, and or persistent villous atrophy despite a gluten-free diet. We detail how to diagnose and distinguish between non-responsive and refractory celiac disease. Finally, we introduce the indications for use of the gluten contamination elimination diet and provide information for practitioners to implement the diet when necessary in their practice.

To examine whether weight recovery among children with weight faltering varied by enrollment age and child and household risk factors.Observational, conducted in an interdisciplinary specialty practice with a skill-building mealtime behavior intervention, including coaching with video-recorded interactions. Eligibility included age 6-36 months with weight/agefifth percentile or crossing of 2 major percentiles. Children were categorized as24 months vs ≥ 24 months. Child and household risk factors were summed into risk indices (top quartile = elevated risks, vs reference). Outcome was weight/age z-score change over 6 months. Analyses were conducted with longitudinal linear mixed-effects models, including age by risk index interaction terms.Enrolled 286 children (mean age 18.8 months, SD 6.8). Significant weight/age recovery occurred regardless of risk index or age. Mean weight/age z-score change was significantly greater among younger compared with older age (0.29 vs 0.17, P = .03); top household risk quartile compared with reference (0.34 vs 0.22, P = .046); and marginally greater among top child risk quartile compared with reference (0.37 vs 0.25, P = .058). Mean weight/age z-score change was not associated with single risk factors or interactions; greatest weight gain occurred in most underweight children.Weight recovery over 6 months was statistically significant, although modest, and greater among younger children and among children with multiple child and household risk factors. Findings support differential susceptibility theory, whereby some children with multiple risk factors are differentially responsive to intervention. Future investigations should evaluate components of the mealtime behavior intervention.