Partition of Urinary Nitrogen in Children with Kwashiorkor Treated with Animal and Vegetable Proteins

Abstract

The pattern of urinary nitrogen partition in patients with kwashiorkor is studied. The effect of different lines of treatment on this pattern are investigated. Nine patients (distributed into four groups) were treated with one of four diets, the protein moiety consisting of either peanut protein isolate, peanut protein plus skim milk, skim milk alone or skim milk plus liver protein. Twenty-four-hour collections of urine were analyzed before commencement of treatment and periodically during treatment for nine nitrogenous constituents, including certain minor compounds, viz., purine derivatives, imidazole compounds and hippuric acid. Nitrogen partition at the height of the disease showed a low percentage of urea nitrogen and a relatively high percentage of ammonia nitrogen, amino nitrogen and undetermined nitrogen. Total urinary nitrogen increased appreciably even on the first day of treatment but the pattern of nitrogen partition remained unaffected. After clinical recovery, there was a considerable rise in urea nitrogen. It was particularly marked in patients receiving animal protein diets and only slight in those receiving vegetable protein diets. Ammonia nitrogen and amino nitrogen returned to normal levels only after successful treatment with animal proteins and animal and vegetable protein mixtures. The response to treatment with peanut protein isolate in this respect was poor. Treatment did not result in the elimination of undetermined nitrogen although it brought about its reduction when animal protein diets were employed. A direct correlation was observed between percentage of urea nitrogen in urine and plasma albumin values before and after treatment. This would suggest that the percentage of urea nitrogen may be as good an index of the severity of kwashiorkor as the serum albumin level.