Study was carried out on 22 patients with chronic renal failure at B¹ch Mai Hospital from 5/1999-7/2000, these had clearance creatinine <30ml/min and creatinine 300-900mmol/l. 22 patients received a very low protein dietary (VLPD) 0.4g protein/kg body weight/24h and supplemented with Ketosteril 1 tablet/5kg/24h. The results: VLPD supplemented with Ketoanalogues can slow the progression of chronic renal failure without malnutritional status, metabolism disorder status of some substances associated with high uremia can be improved. Proteinuria decreased, drug is safe with renal failure patients.
Kidney Failure, Chronic ; Diet, Protein-Restricted ; ketosteril

No abstract available.
Diet, Protein-Restricted ; Renal Insufficiency, Chronic

Ketogenic diet is a high-fat, low-carbohydrate, low-protein diet used in the treatment of epilepsy since 1920's. Recently, it's use for intractable epilepsy in childhood has increased. Complications of ketogenic diet are known to include dehydration, vomiting, diarrhea, renal stones, metabolic derangement, hypercholesterolemia and refusal to eat. We experienced two cases of renal stones in children with intractable epilepsy during ketogenic diet.
Child ; Dehydration ; Diarrhea ; Diet, Protein-Restricted ; Disulfiram ; Epilepsy ; Humans ; Hypercholesterolemia ; Ketogenic Diet* ; Vomiting

OBJECTIVETo investigate whether individualized low-protein diet intervention for patients with chronic kidney disease(CKD)could improve the general condition,slow the deterioration of renal function,and delay the time of entering dialysis.

METHODSForty CKD inpatients between July 2011 and July 2012 were randomly given with normal or individualized low-protein diet for six months according to random number table after signing informed consent. The levels of urine protein and biochemical indexes of renal function were measured at baseline and at the end of dietary intervention for six months, respectively.

RESULTSThe baseline urine protein level,renal function,and biochemical indexes were not significantly different between these two groups. The diastolic blood pressure,protein intake,blood urea nitrogen,uric acid, potassium, phosphorus, C-reaction protein,24-hour urea nitrogen,and urine protein after six months were significantly lower than those at baseline,that is,(101.70 ± 15.78)mmHg vs.(91.75 ±15.52) mmHg,(63.87 ± 24.70)g/d vs.(50.02 ± 14.07)g/d,(20.01 ± 7.69)mmol/L vs.(15.11 ± 4.90) mmol/L,(362.75 ± 84.56)Μmol/L vs.(302.20 ± 8.48)Μmol/L,(5.22 ± 0.75)mmol/L vs.(4.79±0.36) mmol/L,(2.07 ± 0.68) mmol/L vs.(1.57 ± 0.41) mmol/L,1.19 [0.65,4.17] mg/L vs. 0.74 [0.38,1.33] mg/L,70.6 [8.70,101.18] mmol/L vs. 16.93 [3.23,72.27] mmol/L,1.00 [0.30,1.00] g/d vs. 0.15 [0,0.83] g/d (all P<0.05),among which albumin and hemoglobin were significantly higher [(0.34 ± 0.07)g/L vs.(0.37 ± 0.05)g/L, (99.38 ± 21.89)g/L vs.(126.35 ± 14.11)g/L,respectively] in the individualized low-protein diet group. The difference was statistically significant (P<0.05). The most relevant for urine protein producing was prealbumin (r=0.924, P<0.05). The differences of blood urea nitrogen, potassium, sodium, calcium, phosphorus, 24-hour urea nitrogen, urine specific gravity, urine protein, and hemoglobin in six months in the individualized low-protein diet group were significantly better than those in the normal low protein-diet group (P<0.05).

CONCLUSIONSIndividualized low-protein diet intervention may have definite curative effectiveness in CKD patients. It can markedly improve the patients' condition,slow down the deterio-ration of renal function,and increase serum prealbumin levels that may reduce the generation of urine protein. It is worthy of wider clinical application.

Hyperammonemia in the newborn often leads to severe fatal illness associated with hyperammonemic encephalopathy. Transient hyperammonemia in newborns (THAN) is characterized by self-limiting, transient hyperammonemia during the neonatal period. THAN may have favorable long-term outcomes if it is diagnosed early and appropriately managed. However, severe hyperammonemia can develop even in newborns with THAN, which may require emergent management. Here we report a case of THAN with severe hyperammonemia during the neonatal period that was successfully treated with continuous renal replacement therapy and nitrogen-scavenging medications. Our patient went on to develop normally and has not re-experienced a hyperammonemic episode until 9 months of age without the administration of a protein restricted diet or medications.
Diet, Protein-Restricted ; Humans ; Hyperammonemia ; Infant, Newborn ; Renal Replacement Therapy ; Urea Cycle Disorders, Inborn

Methylmalonic acidemia (MMA) is a heterogeneous inborn error of propionate metabolism and its management frequently includes a low-protein diet to minimize precursors of methylmalonic acid and reduce its concentration in body tissues. In the long- term follow-up, renal dysfunction in these patients has been increasingly recognized. Tubulointerstitial nephritis is the most frequent renal complications and has been reported in the small number of renal biopsy specimens from young children previously by others. We report a case of a 18-year-old girl with MMA and renal dysfunction in whom renal biopsy demonstrated chronic tubulointerstitial nephritis.
Adolescent ; Biopsy ; Child ; Diet, Protein-Restricted ; Diethylpropion ; Female ; Follow-Up Studies ; Humans ; Metabolism ; Methylmalonic Acid ; Nephritis, Interstitial*

It is well recognized that malnutrition is one of the most important reversible factors contributing to mortality in hemodialysis patients. Until recently, highprotein diets were recommended for hemodialysis patients in an attempt to increase the synthesis of albumin and to promote the anabolism of body protein. However, the appropriateness of this recommendation has recently been questioned. This study investigated the effects of low and high protein intakes on the levels of serum albumin, total protein, BUN, and creatinine in 28 hemodialysis patients fed sequentially 1.0g(LPG) or 1.5g(HPG) protein and 30-35kcal/kg/ ideal body weight for four weeks. The HPG diet was associated with a significant increase in the levels of serum albumin, total protein, BUN, and creatinine however, the LPG diet was not. The serum levels of triglyceride and total cholesterol were in the normal range and did not changed by the diets. The levels of serum Hb, iron, and transferrin were lower than the normal values and did not changed by these two diets. Though individual considerations are recommended, it is possible that the high protein diet could increase the levels of serum albumin and total protein of the hemodialysis patients in Korea.
Cholesterol ; Creatinine ; Diet ; Diet, Protein-Restricted ; Humans ; Ideal Body Weight ; Iron ; Korea ; Malnutrition ; Metabolism ; Mortality ; Nutritional Status* ; Penicillin G Benzathine ; Reference Values ; Renal Dialysis* ; Serum Albumin ; Transferrin ; Triglycerides

We examined the effect of various levels of dietary protein on long term prognosis of Adriamycinnephropathy of S-D rat, fed with high protein (30%), intermediately low (10%), and strictly low (5%) protein diet for 15 weeks. 1) In rats fed with strictly low protein diets (5%), proteinuria and serum creatinine decreased and creatinine clearance and histological changes were relatively well preserved. But hypoproteinemia and weight loss were more marked and 2 rats died due to severe ascites and pleural effusion in cachexic state. 2) In rats fed with high protein diets (30%), general health condition and weight gain were relatively well preserved. But there were massive proteinuria, progressive increase in serum creatinine and progressive decrease in creatinine clearance. Focal glomerular sclerosis and severe tubulointerstitial change on histologic examination were marked. 3) With intermediately low protein diet (10%), renal function and pasma protein levels were relatively well preserved compared with high protein diet group. But weight gain did not increase normally. 4) We tentatively conclude that appropriately restricted dietary protein can prevent functional and histological renal damage. But too strict protein restriction aggravate nutitional state and general condition.
Animals ; Ascites ; Creatinine ; Diet ; Diet, Protein-Restricted ; Dietary Proteins* ; Hypoproteinemia ; Pleural Effusion ; Prognosis* ; Proteinuria ; Rats ; Renal Insufficiency ; Sclerosis ; Weight Gain ; Weight Loss

Hyperornithinemia-hyperammonemia-homocitrullinuria(HHH) syndrome is a rare autosomal recessive disorder caused by a defect in the urea cycle. Protein intolerance, mental retardation, seizure, ataxia, and stupor are characteristic symptoms. Patients showing these symptoms may also present symptoms of acute hepatic disease at the same time. When fed with a high protein diet, they may refuse to eat, vomit, become lethargic, or go into coma. After childhood, most patients avoid meats or milk spontaneously and eat a low protein diet. The liver and spleen are normal or slightly enlarged. The coagulation time is prolonged and sometimes there is a deficiency in factor VII and X. Treatment is aimed at preventing hyperammonemia after meals by restricting daily protein intake to 1.2 g/kg/day and this lowers serum ornithine concentration. Prolonged ornithine supplement(0.5 to 1.0 mM/kg/day; i.e., 66 to 132 mg/kg/day divided into three doses) improved patients' protein intolerance and accelerated growth. Since Shih and coworkers first reported this syndrome in 1969, there have been 40 cases reported worldwide but not yet in Korea. We, for the first time in Korea, report two cases of HHH syndrome in brothers.
Ataxia ; Coma ; Diet ; Diet, Protein-Restricted ; Factor VII ; Humans ; Hyperammonemia ; Intellectual Disability ; Korea ; Liver ; Meals ; Meat ; Milk ; Ornithine ; Seizures ; Siblings* ; Spleen ; Stupor ; Urea

Ketogenic diet is a high-fat, low carbohydrate, low protein diet used in treatment of pediatric epilepsy since the 1920s. Currently it is used primarily to treat refractory childhood epilepsy. Few serious complications caused by ketogenic diet have been reported. Short-term complications include dehydration, hypoglycemia, vomiting, diarrhea, and refusal to eat. Long-term complications include kidney stones, recurrent infections, metabolic derangement, hypercholesterolemia, irritability, lethargy, and refusal to eat. We experienced 3 cases of infantile spasm patients, whose refractory seizures were controlled with ketogenic diet, but various urinary abnormalities developed.
Dehydration ; Diarrhea ; Diet, Protein-Restricted ; Disulfiram ; Epilepsy ; Humans ; Hypercholesterolemia ; Hypoglycemia ; Infant ; Infant, Newborn ; Ketogenic Diet* ; Kidney Calculi ; Lethargy ; Seizures ; Spasms, Infantile ; Vomiting