EFFECT OF DIETARY-PROTEIN INTAKE ON ALBUMIN HOMEOSTASIS IN NEPHROTIC PATIENTS
EFFECT OF DIETARY-PROTEIN INTAKE ON ALBUMIN HOMEOSTASIS IN NEPHROTIC PATIENTS
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DOI：
10.1038/ki.1986.36
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发表时间：
1986-02-01
影响因子：
19.6
通讯作者：
HUTCHISON, FN
中科院分区：
文献类型：
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作者：
KAYSEN, GA;GAMBERTOGLIO, J;HUTCHISON, FN
与维持正常或高蛋白饮食的动物相比，维持限制蛋白质饮食的患有实验性肾病的动物出现较不严重的肾损伤和较少的蛋白尿。为了确定限制饮食蛋白质是否会减少肾病患者的尿白蛋白排泄，以及这种饮食限制是否会导致白蛋白池减少，我们对九名肾病患者进行了配对研究。他们依次喂食蛋白质含量为 1.6 克/公斤体重的饮食，然后喂食 0.8 克/公斤体重的饮食，每次饮食持续 2 周。热量摄入量保持恒定在 35 K cal/kg。六名患者首先喂食高蛋白饮食；其中三人的饮食给药顺序相反。无论饮食顺序如何，所有低蛋白饮食患者的尿白蛋白排泄量均减少。低蛋白饮食后，白蛋白的肾清除率和肾白蛋白清除率均显着降低。高蛋白饮食的白蛋白合成率更高，但白蛋白尿率也更高。尽管高蛋白质摄入期间白蛋白合成率较高，但血清白蛋白浓度和血浆白蛋白质量均低于低蛋白质摄入期间。因此，患有肾病的患者限制饮食蛋白质会导致尿白蛋白排泄量的减少超过肌酐清除率的减少。在饮食蛋白质限制期间，总白蛋白质量得以保留，而血浆白蛋白质量实际上有所增加。限制蛋白质摄入对于肾病患者可能是可行的。由于高蛋白饮食对肾白蛋白排泄的影响，通过喂食高蛋白饮食来增加这些患者的血清白蛋白浓度的策略可能会失败。
Animals with experimental renal disease maintained on diets restricted in protein develop less severe renal lesions and less proteinuria than do animals maintained on a normal or high protein diet. To determine whether restriction of dietary protein will reduce urinary albumin excretion in patients with established nephroses and whether such dietary restriction will result in decreased albumin pools, we performed paired studies on nine nephrotic patients. They were fed sequential diets with a protein content of 1.6 and then 0.8 g/kg body wt, each for 2 weeks. Caloric intake remained constant at 35 K cal/kg. In six patients the high protein diet was fed first; in three the order of dietary administration was reversed. Urinary albumin excretion was reduced on the low protein diet in all patients regardless of dietary order. Both the renal clearance of albumin and the fractional renal albumin clearance were reduced significantly on the low protein diet. The rate of albumin synthesis was greater on the high protein diet, but so was the rate of albuminuria. Despite the higher rate of albumin synthesis during the period of high protein intake, serum albumin concentration and plasma albumin mass were both less than during the period of low protein intake. Thus, dietary protein restriction in patients with established nephrosis results in decreased urinary albumin excretion in excess of any reduction in creatinine clearance. Total albumin mass is preserved and plasma albumin mass is actually increased during the period of dietary protein restriction. Protein restriction may be feasible in nephrotic patients. The strategy of increasing serum albumin concentration in these patients by feeding them a high protein diet may fail because of the effect of high protein diets on renal albumin excretion.