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7 Effects of Protein Intake on Renal Function and on the Development of Renal Disease
Pages 137-154

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From page 137...
... In recent years, much effort has been directed toward defining the optimum protein intake for patients with chronic renal failure, with the aim of slowing the rate of progression toward the end stage. Despite many reports, it is still not firmly established that protein restriction slows disease progression, although the bulk of available evidence supports this conclusion (for example, Fouque et al., 1992; Levey et al., 1996~.
From page 138...
... . Calcium Excretion and Calcium-Containing Stones Calcium Intake Calcific nephrolithiasis occurs when the activity products of free calcium times free oxalate or phosphate exceeds a certain level, which is in turn modified by crystallization inhibitory factors.
From page 139...
... Many workers have confirmed these relationships in humans. Thus, a high sodium intake augments and a low sodium intake diminishes calcium clearance.
From page 140...
... reported that infusion of sodium sulfate in dogs caused a pronounced increase in calcium clearance (Figure 7-2 - greater than the attendant increase in sodium clearance. This study showed that ion-pair formation between calcium and sulfate accounted for this effect, since the clearance of free calcium ions remained approximately equal to the clearance of sodium (Figure 7-3)
From page 141...
... (1991) have demonstrated that potassium administration reduces and potassium deprivation increases urinary calcium, possibly because of associated changes in sodium excretion or in calcitriol synthesis.
From page 142...
... Oxalate excretion after ingesting oxalate and the increase in calcium oxalate supersaturation of the urine are greater than in control subjects, provided that both groups are ingesting a high protein diet (Urivetzky et al., 1987~. Animal protein causes more calciuria than vegetable protein but, unlike the latter, does not increase urinary oxalate (Marangella et al., 1989~.
From page 143...
... Protein restriction augments citrate excretion in hypercalciuric stone formers and reduces stone incidence but may not affect uric acid excretion (Goldfarb, 1988~. Sodium restriction reduces urinary calcium in hypercalciuric subjects (Muldowney et al., 1982~.
From page 144...
... It is clear, however, that at least with regard to the risk of morbidity from acute renal failure, dietary protein restriction is more likely to confer benefit than to increase risk. PROTEIN INTAKE AND THE DEVELOPMENT OF GLOMERULOSCLEROSIS Glomerular filtration rate (GFR)
From page 145...
... Rats prefer rations containing higher proportions of protein, and the earlier studies indicating that protein restriction retarded renal damage failed to monitor food intake. Second, protein restriction tends to lower GFR rather than increase it.
From page 146...
... Lew and J.P. Bosch, 1991, Effect of diet on creatinine clearance and excretion in young and elderly healthy subjects and in patients with renal disease, J
From page 147...
... In dogs with 75 percent nephrectomy, GFR does not decline progressively with time for the ensuing 4 years, whether protein intake is high or low (Bovee, 1991~. In baboons followed for 5 years after subtotal nephrectomy and on either 8 percent protein or 25 percent protein diets, renal failure did not occur; GFR, measured as inulin clearance, increased sharply in baboons fed 25 percent protein, and this difference tended to disappear with time (curiously, creatinine clearances did not decrease with time in either group)
From page 148...
... 1982. Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically moderated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation and intrinsic renal disease.
From page 149...
... 1991. Potassium administration reduces and potassium deprivation increases urinary calcium excretion in healthy adults.
From page 150...
... 1996. Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study.
From page 151...
... 1991. The influence of diet on urinary risk factors for stones in healthy subjects and idiopathic renal calcium stone formers.
From page 152...
... I have to re-orient my thinking in that regard. STEVEN HEYMSFIELD: There were studies of protein restriction in people with chronic renal failure I believe.
From page 153...
... I think that the bottom line at the moment is Hat protein restriction probably does slow progression. It certainly reduces symptoms, there is no question.
From page 154...
... So I am sure that there are instances in which renal failure results from partial nephrectomy or absence thereof and that probably could be ameliorated by protein restriction. ROBERT NESHEIM: Thank you.


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