0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

The Role of Dietary Protein in Progressive Renal Disease

Ben H. Brouhard, MD
Am J Dis Child. 1986;140(7):630-637. doi:10.1001/archpedi.1986.02140210028019.
Text Size: A A A
Published online

• Recently, a renewed interest in the role of dietary protein intake in the treatment of progressive renal disease has occurred. Early investigators suggested that high protein intake had a deleterious effect on renal function. Animals fed a high protein intake had more proteinuria and more-extensive glomerular sclerosis compared with animals fed a normal protein intake. More recent investigations have revealed that not only will a high protein intake exacerbate renal disease but a low protein intake will slow and/or prevent decline in renal function and the severity of renal histologic changes. These studies have provided the stimulus for investigations involving humans. Such studies suggest that patients with progressive renal disease of various causes, when placed on low-protein diets (0.6 g/kg/d), exhibit a slowing of the decline in renal function. The mechanism of the halting of such progression has been suggested to be a reduction in the hyperfiltration that occurs in the remaining nephrons after renal injury is established. Micropuncture studies have indicated that after the kidney has suffered injury, either through disease process or surgical removal, the unaffected nephrons try to maintain overall function, with individual nephrons increasing their filtration. This increase in single-nephron glomerular filtration rate (GFR) is accompanied by increases in single-nephron blood flow and an increase in transcapillary pressure, with altered membrane permeability, resulting in increased proteinuria. This increase in filtered albumin is taken up by the mesangium, with resulting mesangial expansion and glomerular sclerosis, with impingement on the glomerular filtering surface area, ultimately resulting in further decreases in GFR. Lowering protein intake will prevent this hyperfiltration, albuminuria, and the histologic changes. Furthermore, whether reduced protein intake is needed during times of physiologic increases in GFR (pregnancy, unilateral nephrectomy) is not clear. The processes that occur from the time after ingestion of protein to changes in GFR are not known but are probably mediated by systemic or intrarenal hormones. When adjusting protein intake, the minimum recommended dietary allowance for daily protein requirements must be considered. In adults, this level is 0.5 g/kg/d, with lower intakes requiring supplementation with essential amino acids. Requirements for children vary according to age—the younger the child, the higher the requirement. Minimum requirements for children with renal insufficiency have not been established. However, reduced protein intake is warranted, in addition to other therapies, in patients with renal insufficiency to reduce the potential for progression to end-stage renal disease.

(AJDC 1986;140:630-637)

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();