Effects of dietary protein in patients with chronic renal transplant rejection.
Effects of dietary protein in patients with chronic renal transplant rejection.
复制标题
膳食蛋白质对慢性肾移植排斥反应患者的影响。
DOI：
10.1038/ki.1992.25
复制
发表时间：
1992
影响因子：
19.6
通讯作者：
Rosenberg,ME
中科院分区：
文献类型：
--
作者：
Salahudeen,AK;Hostetter,TH;Raatz,SK;Rosenberg,ME
膳食蛋白对慢性肾移植排斥反应患者的影响。在天然肾脏的各种肾脏疾病中，限制饮食蛋白质可以减少蛋白尿并减缓肾功能衰竭的进展。这种有益的作用可能是通过饮食蛋白对肾脏的多重影响，包括对肾小球毛细血管血流动力学和肾素加压素系统的影响。然而，限制饮食蛋白质在慢性肾移植排斥反应治疗中的作用尚不清楚。因此，本研究旨在研究限制饮食蛋白对慢性排斥反应患者的影响。14例经活检证实为慢性排斥反应的患者，自选家庭饮食(1.0±0.1g蛋白质/kg/天)，采用交叉设计，分为两个11天组，一组为低蛋白饮食(0.55g/kg/d)，另一组为高蛋白饮食(2g/kg/d)。研究了这些饮食对肾脏血流动力学、蛋白尿、血浆肾素活性和营养状况的影响。低蛋白饮食与所有患者肾小球通透性的显著改善有关，表现为白蛋白和免疫球蛋白的部分清除显著下降，24小时尿总蛋白、白蛋白和免疫球蛋白排泄减少，而血压、肾小球滤过率或肾血浆流量没有任何变化。与每种饮食开始时的蛋白尿相比，高蛋白饮食并没有增加，但低蛋白饮食显著减少了蛋白尿。低蛋白质饮食还与血浆肾素活性显著降低有关，这表明限制蛋白质饮食的部分有益效果与肾素-血管紧张素系统的抑制有关。蛋白质限制也与血清蛋白质适度但显著的下降有关。总而言之，低蛋白饮食可减少慢性排斥反应患者的蛋白尿并降低血浆肾素活性。限制饮食蛋白可能通过抑制肾素-血管紧张素系统改善慢性排斥反应中肾功能衰竭的病程。需要研究来确定这些患者的饮食蛋白限制的安全水平，并评估这种限制在减缓肾功能衰竭进展方面的有效性。
Effects of dietary protein in patients with chronic renal transplant rejection. Dietary protein restriction reduces proteinuria and slows the progression of renal failure in a variety of renal diseases in native kidneys. Such beneficial effects may be mediated by the multiple renal effects of dietary protein including those on glomerular capillary hemodynamics and the reninrangiotensin system. The role of dietary protein restriction in the management of chronic renal transplant rejection is, however, unclear. This study was therefore undertaken to examine the effects of dietary protein restriction in patients with chronic rejection. Fourteen patients with biopsy proven chronic rejection, who had been on a self-selected home diet of 1.0 ± 0.1 g protein/kg/day, were randomly assigned, using a crossover design to two 11-day periods, one on a low protein diet (0.55 g/kg/day) and the other on a high protein diet (2 g/kg/day). The effect of these diets on renal hemodynamics, proteinuria, plasma renin activity, and nutritional status was examined. The low protein diet was associated with a significant improvement in glomerular permselectivity in all patients as evidenced by a significant fall in the fractional clearance of albumin and IgG and reduction in 24-hour urinary excretion of total protein, albumin and IgG without any change in blood pressure, glomerular filtration rate, or renal plasma flow. Compared to the proteinuria at the beginning of each diet, a high protein diet did not increase but a low protein diet significantly decreased the proteinuria. The low protein diet was also associated with a significant reduction in plasma renin activity, suggesting that part of the beneficial effect of protein restriction was related to the suppression of the renin-angiotensin system. Protein restriction was also associated with modest but significant falls in serum proteins. In conclusion, a low protein diet reduces proteinuria and lowers plasma renin activity in patients with chronic rejection. Dietary protein restriction may improve the course of renal failure in chronic rejection partly by suppressing the renin-angiotensin system. Studies are needed to establish the safe level of dietary protein restriction in these patients and to assess the efficacy of such restriction in slowing the progression of renal failure.