The Impact of Malnutrition on Kidney Function

Abstract

Malnutrition is the most common cause of mortality in the world. It affects underdeveloped as well as industrialized societies, in the latter demonstrating a prevalence in hospitalized patients of between 30 and 50%. Although the prevalence has decreased in recent studies, the problem is still significant among a selected group of patients. The clinical manifestations of malnutrition may be evident on physical examination but alterations in renal function may not show up at the initial exam. Clinical and experimental models of protein-calorie malnutrition have confirmed significant alterations in renal hemodynamics, renal concentration capacity, and renal acid excretion. Children and adults with malnutrition have been shown to have a decreased glomerular filtration rate and renal plasma flow (RPF), as well as a lowered capacity to concentrate the urine and excrete an acid load. Moreover, clinical and experimental models of protein-calorie malnutrition have unravelled the roles of the renin-angiotensin system, renal prostaglandins, and urea production in the renal function changes associated with malnutrition. We have reviewed the most pertinent and recent studies from our and other laboratories which have improved our understanding of renal functional alterations in malnutrition.

Acute kidney injury after open ventral hernia repair: an analysis of the 2005–2012 ACS-NSQIP datasets

“…The association between malnutrition as evident by hypoalbuminemia and AKI is to some extent intuitive, as patients with malnutrition have been shown to have decreased GFR and renal plasma flow. Indeed, these patients' kidney function as a whole is suboptimal, as they often also have difficulty concentrating urine and excreting acid [23].…”

Mechanisms Involving Ang II and MAPK/ERK1/2 Signaling Pathways Underlie Cardiac and Renal Alterations during Chronic Undernutrition

“…[10], [11]). As an example of combined vascular and renal alterations, early studies demonstrated that an isocaloric-hypoproteic diet in rats led to hemodynamic alterations, in which increased afferent and efferent arteriolar resistance was responsible for a decline in both glomerular filtration rate and renal blood flow [12].…”

A Low Protein Diet Causes an Increase in the Basal Levels and Variability of Mean Arterial Pressure and Heart Rate in Fisher Rats

“…Malnutrition early in life produces a severe impact on the development of the body, resulting in a reduced rate of protein synthesis in most body tissues (Keller et al, 1982;Pedrosa and MoraesSantos, 1987). Clinical and experimental evidences have shown that protein malnutrition may affect several systems involved in the homeostasis of the body (Viart, 1977;Yokogoshi et al, 1992;Benabe and Martinez-Maldonado, 1998). Regulation of the cardiovascular system invariably involves the activation of several groups of receptors whose inputs to the central nervous system (CNS) result in negative feedback loops, to achieve and maintain the homeostasis (Machado et.…”