Treatment of nephrotic adults with a supplemented, very low-protein diet.
Treatment of nephrotic adults with a supplemented, very low-protein diet.
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用补充的极低蛋白质饮食治疗成人肾病。
DOI：
10.1016/s0272-6386(96)90492-8
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Tomalis,EA
中科院分区：
文献类型：
--
作者：
Walser,M;Hill,S;Tomalis,EA
肾病综合征成人的最佳饮食蛋白质摄入量尚未确定;认为极低蛋白饮食是禁忌的。尽管如此，16名肾病综合征患者仍接受了平均10个月（范围1至36个月）的极低蛋白饮食（0.3 g/kg），补充10至20 g/d必需氨基酸（或在少数情况下，酮酸）。在11例初始肾小球滤过率（GFR）≤30 mL/min/3 m2身高（ht）2的患者中，观察到蛋白尿、血清白蛋白和血清胆固醇（平均）显著但适度的改善;所有11例最终继续透析。其他5名患者，初始GFR为32至69 ml/min/3 m2的ht 2，有局灶节段性肾小球硬化症，糖尿病肾病，或在一名患者，两者兼而有之。与这些疾病相关的肾病综合征很少能自发缓解。然而，在随后的3至15个月内，平均蛋白尿从9.3 g/d降至1.9 g/d，平均血清白蛋白从2.5 g/dL升至3.8 g/dL，平均血清胆固醇从415 mg/dL降至255 mg/dL（均P < 0.001）。GFR保持不变或增加。这5名患者中有4名已恢复正常或接近正常饮食，并保持缓解或接近缓解6至24个月。我们的结论是，严重的蛋白质限制加上必需氨基酸补充剂可能会导致长期缓解的成人肾病综合征，肾小球滤过率没有严重降低。这种对蛋白质限制的矛盾反应的机制仍有待确定。
Optimal dietary protein intake for adults with the nephrotic syndrome has not been established; very low-protein diets are believed to be contraindicated. Sixteen patients with the nephrotic syndrome were nevertheless prescribed a very low protein diet (0.3 g/kg) supplemented by 10 to 20 g/d essential amino acids (or, in a few cases, ketoacids) for an average of 10 months (range, 1 to 36 months). In 11 patients with initial glomerular filtration rates (GFRs) ≤30 mL/min/3 m2of height (ht)2, significant but modest improvement was seen (on the average) in proteinuria, serum albumin, and serum cholesterol; all 11 eventually went on to dialysis. The other five patients, with initial GFRs of 32 to 69 ml/min/3 m2of ht2, had either focal segmental glomerulosclerosis, diabetic nephropathy, or, in one patient, both. The nephrotic syndrome associated with these disorders rarely remits spontaneously. However, during the following 3 to 15 months mean proteinuria decreased from 9.3 to 1.9 g/d, mean serum albumin increased from 2.5 g/dL to 3.8 g/dL, and mean serum cholesterol decreased from 415 mg/dL to 255 mg/dL (all P < 0.001). The GFR either remained constant or increased. Four of these five patients have resumed normal or nearly normal diets and remain in remission or near-remission for 6 to 24 months. We conclude that severe protein restriction plus an essential amino acid supplement may induce prolonged remission in adults with the nephrotic syndrome provided that GFR is not severely reduced. The mechanism of this paradoxical response to protein restriction remains to be determined.