Twenty-six patients with advanced renal failure (glomerular filtration rate less than 6 ml/min) were treated with a mixed quality low protein diet and ketoacid analogues. An improvement in nitrogen balance, serum transferrin and phosphate, and base excess was observed after 2 weeks of treatment. In a longer term study, the result of 20 patients treated with ketoacids for up to 14 months were compared to a group 40 patients who received a low-protein diet with essential amino acids. Patients responded similarly to the two diets; however, the group receiving ketoacids had a significantly lower glomerular filtration rate. There was improvement in calcium and phosphate metabolism with ketoacid treatment. The patients were able to tolerate treatment with both the ketoacids and vitamin D.
In a group of 119 patients with advanced chronic renal failure (serum creatinine level 733 ± 186 μmol/l) the effect of a low-protein diet supplemented with essential amino acids (EAA) or their keto analogues (KA) on uremic metabolism and rehabilitation status was investigated. The protein intake amounted to 0.4 g/kg B.W./day, the phosphorus intake 0.4–0.6 g/day and the energy supply 120–150 kJ/kg B.W./day. In 51 patients there was a substitution with EAA and in 68 patients with their KA. The mean duration of dietary treatment in this study was 19 months (6–64 months). During this time, the serum creatinine increased from 733 + 186 to 1,220 ± 256 μmol/l, whereas the urea nitrogen values remained relatively constant at between 26 and 30 mmol/l. There were no signs of protein malnutrition (nitrogen balance, serum transferrin and serum protein were normal). The hemoglobin concentration remained at > 5 mmol/l with creatinine levels of 1,220 ± 256 μmol/l. During the substitution with KA, there was a significantly greater decrease in serum phosphate (p < 0.05) and parathyroid hormone (PTH) (p < O.01) as compared with the uremics given EAA. In addition, we found a significant increase in testosterone (p < O.Ol) in patients supplemented with KA. Despite advanced chronic renal failure there was a good degree of rehabilitation (full-time work: 21%; part-time work: 66.4%). It can be concluded that a low-protein diet supplemented with EAA or KA can improve the uremic metabolism, rehabilitation status and safely postpone the start of maintenance dialysis.
The tubular and tubulointerstitial renal functions of 237 patients with chronic glomerulonephritis and functional compensation corresponding to their plasma creatinine levels were investigated and the results were compared with the light microscopic findings obtained by examination of kidney interstices obtained by biopsy. Pronounced structural interstitial lesions (TiC) were found in 30% of the cases. Investigation of the predictive values of tubular function data in respect of the presence or exclusion of TiC showed that, although individual parameters of the renal function permit the exclusion of TiC disturbances with a high degree of certainty, the diagnostic value can be enhanced by considering pairs of such parameters. Five parameter combinations were found to have the highest predictive value regarding the diagnosis of TiC. These were disturbed concentration capacity accompanied by reduced ammonia excretion or total acid excretion, reduced water diuresis accompanied by disturbed ammonia excretion or total acid elimination; and, finally, the total acid excretion and maximum dilution capacity. The highest predictive values for the exclusion of TiC are shown by inconspicuous concentration capacity accompanied by normal ammonia excretion, total acid excretion, water diuresis, free water clearance or urine dilution capacity.
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