24-hour Protein Research Articles

Increasing the Protein Content of Meals and Its Effect on Daily Energy Intake

High-protein preloads have been shown to enhance satiety, but little is known about the satiating effects of protein in more typical situations when meals are consumed ad libitum. To investigate the effects of protein in amounts commonly consumed over a day, a crossover study was conducted in 2008. In this experiment, 18 normal-weight women consumed ad libitum lunch and dinner entrées 1 day a week that were covertly varied in protein content (10%, 15%, 20%, 25%, or 30% energy). Entrées were manipulated by substituting animal protein for starchy ingredients and were matched for energy density, fat content, palatability, and appearance. Unmanipulated breakfasts and evening snacks were consumed ad libitum. Participants rated their hunger and fullness before and after meals as well as the taste and appearance of entrées. Data were analyzed using a mixed linear model. Results showed that mean 24-hour protein intake increased significantly across conditions, from 44±2 g/day in the 10% protein condition to 82±6 g/day in the 30% condition. Daily energy intake did not differ significantly across the 10% to 30% protein conditions (means 1,870±93, 1,887±93, 1,848±111, 1,876±100, and 1,807±98 kcal in the 10%, 15%, 20%, 25%, and 30% energy groups, respectively). There were no significant differences in hunger and fullness ratings across conditions or in taste and appearance ratings of the manipulated entrées. This study showed that varying the protein content of several entrées consumed ad libitum did not differentially influence daily energy intake or affect ratings of satiety.

Comparison of Urinary Albumin and Urinary Total Protein as Predictors of Patient Outcomes in CKD

Proteinuria is common and is associated with adverse patient outcomes. The optimal test of proteinuria to identify those at risk is uncertain. This study assessed albuminuria and total proteinuria as predictors of 3 patient outcomes: all-cause mortality, start of renal replacement therapy (RRT), and doubling of serum creatinine level. Retrospective longitudinal cohort study. Nephrology clinic of a city hospital in Scotland; 5,586 patients with chronic kidney disease (CKD) and proteinuria measured in random urine samples (n = 3,378) or timed urine collections (n = 1,808). Baseline measurements of albumin-creatinine ratio (ACR), total protein-creatinine ratio (PCR), 24-hour albuminuria, and total proteinuria. All-cause mortality, start of RRT, and doubling of serum creatinine level were assessed using receiver operating characteristic curves and Cox proportional hazards models. Blood pressure, serum creatinine level, ACR, PCR, date of death, date of starting RRT. Patients were followed up for a median of 3.5 (25th-75th percentile, 2.1-6.0) years. For all outcomes, adjusted HRs were similar for PCR and ACR (derived from random urine samples and timed collections): death, 1.41 (95% CI, 1.31-1.53) vs 1.38 (95% CI, 1.28-1.50); RRT, 1.96 (95% CI, 1.76-2.18) vs 2.33 (95% CI, 2.06-3.01); and doubling of serum creatinine level, 2.03 (95% CI, 1.87-2.19) vs 1.92 (95% CI, 1.78-2.08). Receiver operating characteristic curves showed almost identical performance for ACR and PCR for the 3 outcome measures. Adjusted HRs for ACR and PCR were similar when derived from random urine samples or timed collections and compared with 24-hour total protein and albumin excretion for each outcome measure. This is a retrospective study. Total proteinuria and albuminuria perform equally as predictors of renal outcomes and mortality in patients with CKD. ACR and PCR were as effective as 24-hour urine samples at predicting outcomes and are more convenient for patients, clinicians, and laboratories. Both ACR and PCR stratify risk in patients with CKD.

Increased Risk of Hypertension, Proteinuria and Preeclampsia in Pregnant Saudi Females with IgA Nephropathy

Background. IgA nephropathy is fairly prevalent in Saudi Arabia. In this paper we examine the natural history of pregnancies and their impact on renal function in Saudi females affected by this condition. Methods. We followed a series of 12 patients, documented to have IgA nephritis by kidney biopsy, during their gestation. We monitored their blood pressure, serum creatinine, creatinine clearance, 24-hour protein before conception and at the third trimester of pregnancy. We also documented any maternal or fetal complications. Results. All patients had well-controlled blood pressure, normal renal function, and proteinuria of less than one gram per day prior to conception. During pregnancy, all patients (100%) developed hypertension-requiring treatment and three of them (25%) developed preeclampsia. One patient (8.3%) had hemolysis, elevated liver enzymes, and, low platelets syndrome. All patients had worsening of their proteinuria during pregnancy from 535.2 (101.4) to 2179.2 (636.6) mg/24 h (p < 0.01) with a decrease in creatinine clearance from 88.6 (7.6) mls/min to 77.4 (5.9) mls/min (p < 0.05). No fetal complications were observed. Conclusion. We conclude that pregnancies in patients, even with mild IgA nephritis, require close observation as there is an increased incidence of worsening hypertension and preeclampsia.

Correlation between podocyte excretion and proteinuria in diabetic nephropathy patients

Objective To observe the podocyte injury in diabetic nephropathy (DN) patients by identifying the urinary podocytes and the situation of detached podocytes in glomeruli and to demonstrate the correlation between podocyte excretion and proteinuria, blood glucose, serum creatinine in different phases in DN patients. Methods Urinary podocytes and the podocalyxin (PCX) expression state of podocytes in glomeruli were identified and observed by indirect immunofluorescent method. The DN patients were divided into three groups according to the volume of proteinuria, namely small, medium and large volume proteinuria groups. The podocytes in the urine of every group were calculated. The DN patients were divided into five groups according to the chronic kidney disease (CKD) phases, then the positive podocytes in urine were calculated. Meanwhile, the 24-hour protein in urine, fasting blood glucose (FBG) and the serum creatinine of DN patients were tested. The correlations among the proteinuria, serum creatinine, FBG and the number of positive podocytes in the urine of DN patients were statistically analyzed. Results Urinary positive podocytes were found in 88% of the patients with DN, whereas podocytes were found in 0% of patients with minimal changed disease (MCD) and healthy cases. The expression of PCX was absent in DN patients. In contrast, PCX was expressed integrally in MCD patients. The positive podocytes was 1.49±0.95/ml in small-volume proteinuria group, 2.15±0.70/ml in the medium-volume proteinuria group, and 3.48±1.27/ml in the large-volume proteinuria group. There was no significant difference between the small- and medium-volume proteinuria groups, and there were significant differences between other groups ( P<0.05). The positive podocyte number tended to increase as proteinuria was increased. By Pearson analysis, the correlation between podocyte number and proteinuria was positive statistically. The difference of the number of positive podocytes in urine from different groups of DN patients, CKD I - V group was significant statistically. The correlation between serum creatinine of CKD I - III group and positive podocytes in urine was positive statistically. The correlation between serum creatinine of CKD IV - V group and positive podocytes in urine was not significant statistically. The correlation between FBG and positive podocytes in urine was not significant either. Conclusion The mechanism of the podocyte injury in DN patients is present. The podocyte injury in DN may positively correlate to proteinuria and serum creatinine of CKD I - III DN patients, but not to the FBG and serum creatinine of CKD IV - V patients.

Quantitative Evaluation of Proteinuria by Estimation of the Protein/Creatinine Ratio in a Random Urine Sample

The aim of this study was to evaluate the severity of proteinuria using the protein/creatinine ratio in a random urine sample. In 45 patients (male 28, female 17; mean age 50.68 ± 18.26 years) with proteinuria of various causes, we measured the 24-hour protein excretion per 1.73 m2 of body surface and, during the same day, the protein/creatinine ratio in three different urine samples (8 am, 12 pm, 4 pm). The 24 h proteinuria was defined as mild (<1 g), moderate (1–3.4 g), and severe (>3.4 g) in 7, 27, and 11 patients, respectively. The sensitivity for protein/creatinine ratio compared to the 24 h proteinuria as a method of reference was 86–100% in the mild, 78–100% in the moderate, and 73–82% in the severe proteinuria, whereas the specificity was 84–100%, 78–83%, and 100% respectively. The patients with better renal function had significantly higher proteinuria levels. There was a similarity in the 24 h proteinuria and the protein/creatinine ratio measurements in all renal function and level-of-proteinuria groups. The protein/creatinine ratio of the morning and midday samples had a very good association with the 24 h sample, whereas it was not associated significantly with the evening sample (4 pm). In conclusion, the degree of 24 h proteinuria levels can be evaluated by calculating the protein/creatinine ratio in a random urine sample collected at any time from morning until midday. Protein/creatinine ratio is independent of the severity of proteinuria or renal function, and it can replace in clinical practice the cumbersome 24 h urine collections.

Is morning urinary protein-to-creatinine ratio a reliable estimator of 24-hour proteinuria in patients with kidney diseases?

Proteinuria is the most frequent marker of kidney damage. Although 24-hour urinary proteinuria is the gold standard, the measurement of proteinuria from albumin urinary creatinine ratio is proposed as much useful method. To evaluate the accuracy of urine protein-to-creatinine (P/Cr) ratio in morning urine specimens as compared with 24-hour total protein excretion for the measurement of proteinuria in patients with different kidney diseases and different renal function levels. Proteinuria in the studied patients was assessed by 24-hour protein excretion (24-hour PRT) and spot urine P/Cr ratio. The analysis of concordance between 24-hour PRT and P/Cr was carried out using intraclass correlation coefficient (ICC), paired t-test and Bland-Altman plots. The discriminant cutoff values for spot urine P/Cr ratio in predicting 24-hour protein "threshold" excretion were determined using receiver operating characteristic curves (ROC), as well as sensitivity and specificity. A total of 303 patients were included in the study. The concordance between 24-hour PRT and P/Cr ratio was excellent (ICC 0.931). Systematic overestimation of PRT by urinary P/ Cr ratio was disclosed (mean difference 0.138, p = 0.011). The P/Cr of 0.25 (sensitivity 0.90; specificity 0.96), 0.66 (1.00; 0.91) and 2.55 (1.0; 0.97) g/g reliably predicted 24-hour urine total protein equivalent "thresholds" at 0.2, 1.0 and 3.5 g/day. The chronic renal failure group independently positively influenced the difference between 24-hour PRT and P/Cr. It means the lower the kidney function the higher is the difference between the two proteinuria measurements. This study supports the recommendation of using spot urine P/Cr ratio in proteinuria screening in patients with different kidney diseases. The obtained results indicated better agreement between morning P/Cr and 24-hour PRT in patients with lower proteinuria and better kidney function.

The Relationship Between Serum Free Light Chain Levels and Urine Protein in Patients with IgG or IgA Myeloma.

Abstract 1810Poster Board I-836The serum free light chain (SFLC) assay is often though to be a replacement for the cumbersome process of 24-hour urine collection for monoclonal protein estimation (http://www.freelite.co.uk/initialinvestigationpro-24.asp; accessed 16 July 2009) despite evidence suggesting that SFLC estimation cannot replace urine protein quantification (Singhal et al. Blood 2007; 109:3611-2). We studied results from patients with IgG or IgA myeloma if all the following criteria were satisfied: concomitant SFLC and 24-hour urine specimens analyzed, no oligoclonal proteins, no diminished free light chain levels (involved or uninvolved). The aim was to study the correlation between SFLC and 24-hour urine total protein (24UTP), 24-hour urine monoclonal protein (24UMP) and urine immunofixation electrophoresis (UIFE). Only concordant abnormal SFLC ratios were considered abnormal (Singhal et al. Blood 2009; 114:38-9). 558 samples in 114 patients were identified. SFLC ratio was abnormal in 242 and normal in 316 (including 2 discordant abnormal). UIFE (available in 540) was negative in 290. The proportion of samples with normal SFLC ratio decreased as 24UTP increased (P<0.001): ≤200 mg - 75% of 243, 200-500 mg 33% of 129, 501-1000 mg - 24% of 54, and >1000 mg - 6% of 32. Similarly, the proportion of samples with normal SFLC ratio declined as 24UMP increased (P=0.001): ≤200 mg (including negative) - 41% of 145, 200-500 mg 4% of 28, 501-1000 mg - 0% of 14, and >1000 mg - 0% of 15. SFLC ratio was normal in 84% of samples with negative UIFE and in 26% of samples with positive UIFE (P<0.0001). Among the 47 samples with abnormal SFLC ratio and negative UIFE, the 24UTP was 47-288 mg (median 112). 24UMP was 35 mg in 1, “faint” in 1, and no restricted bands were seen in ther remaining 45. The table shows the relationship between UPEP, UIFE and SFLC amongst the 540 samples where all 3 tests were available. The presence of any restricted band on UPEP, even if too small to quantify, was considered positive.n=540Positive UPEPNegative UPEPPositive UIFENegative UIFEPositive UIFE22228Negative UIFE17273Abnormal SFLC ratio1725918447Normal SFLC ratio6724266243If a positive UPEP is considered the “gold standard” evidence of the presence monoclonal light chains in the urine, the sensitivity of UIFE in detecting urine monoclonal protein is 93% and that of an abnormal SFLC ratio is 72%. On the other hand, if a positive UIFE is considered the “gold standard” evidence of monoclonal light chains in the urine, the sensitivity of an abnormal SFLC ratio in detecting urine monoclonal protein is 74%. These data, obtained from a much large number of homogeneous clinical samples, confirm our previous observations (Singhal et al. Blood 2007; 109:3611-2) that an abnormal SFLC ratio cannot consistently predict the presence of either non-specific or monoclonal proteinuria. Fortunately, the proportion of urine samples with large aounts of non-specific or monoclonal proteinuria that is associated with normal SFLC ratios is small. The sensitivity of the SFLC ratio in detecting urine monoclonal protein is less than that of UIFE. The SFLC assay cannot replace 24-hour urine collection in clinical practice without compromising patient care. Whether a less cumbersome technique such as a spot (random) urine protein-creatinine ratio - used in conjunction with the SFLC assay - can avert the need for 24-hour urine collections in myeloma patients remains to be investigated. DisclosuresNo relevant conflicts of interest to declare.

Effect of Sickle Cell Disease Type, Age and Gender On the Prevalence of Chronic Organ Damage in Adults with Sickle Cell Disease.

Abstract 4607 IntroductionThe high mortality risk that sickle cell disease (SCD) patients experience from infancy is cumulative through adulthood, largely because of the effect of cumulative end organ damage, which is a more powerful predictor of early mortality than frequency of painful episodes. The latter, though, gets more attention from patients and caregivers. Any vascular territory is susceptible to damage. The most common target organs are the brain, lungs, kidneys, retina and joints. We examined the prevalence of the full spectrum of end organ damage in a cohort upon entry into our adult SCD program and compared the clinical and laboratory characteristics of patients based on age, gender and SCD type. Patients and MethodsRetrospective review of prospectively collected data on 118 adults upon entry into our program between February 2005 and October 2008. All patients underwent a standardized battery of tests to evaluate hematological and biochemical parameters at entry. Historical presence of episodes of acute chest syndrome, pneumonia, stroke, avascular necrosis, osteomyelitis, leg ulcers, priapism, and cholecystectomy and hydroxurea therapy was quantified. Pulmonary hypertension (PHT) was defined as a tricuspid regurgitant jet velocity (TRJV) ≥2.5 m/s on Doppler echocardiography; sickle cell nephropathy (SCN) as glomerular filtration rate, (GFR) < 90ml/min. and/or 24-hour protein>300mg and/or urine protein/creatinine ratio>0.3); cerebrovascular disease (CVD) as evidence of previous ischemic and/or hemorrhagic infarct and/or aneurysm formation on brain MRI/MR angiography; and sickle cell retinopathy (SCR) as background to proliferative retinopathy) on fluorescent retinal angiography. Characteristics of patients were evaluated with t-test for continuous variables and chi-square test for the categorical variables. ResultsThe relevant statistically significant correlative variables in these 3 comparisons are shown in the following tables.Table 1Age comparison:NAge (years)p-value<20 (n=62)20 to<30 (n=22)30 to <40 (n=18)≥40 (n=16)Clinical and Laboratory FeaturesAvascular necrosis %1188.064.5516.6737.50.0087*Leg ulcers %1181.614.5527.7837.5<.0001*Bilirubin (mean)1163.05 ±2.272.79 ±2.22.28 ±1.511.7 ±1.970.0317*End Organ DamageSCR %6820.5142.8653.8588.890.001*SCN %923657.1471.4385.710.0032*Table 2Gender ComparisonNFemales (n=58)Males (n=60)p-valueClinical and Laboratory FeaturesHydroxyurea therapy %11812.0736.670.0019*Hemoglobin (mean)1179.13±1.7410.4±2.330.0011*Urine protein/Cr ratio (mean)910.51±0.750.23±0.320.0199*24 hour urine protein (mean)84489.39±634.93231.14±241.620.019*Table 3Comparison between SCD typesNSC (n=27)SS/Sβ0 (n=74)p-valueClinical and Laboratory FeaturesAge (mean)10132.76±14.9324.42±9.370.0104*Pneumonia (mean no. of episodes)1010.44±1.221.57±1.970.0006*Priapism %555.8828.950.0796Cholecystectomy %1017.4147.30.0002*Hydroxyurea therapy %1013.733.780.0022*Hemoglobin (mean)10111.99±1.638.67±1.49<.0001*MCV (mean)10184.53±11.0792.74±13.890.0068*Reticulocyte count, absolute (mean)62186.46±64.57279.57±98.670.0015*Reticulocyte, percentage (mean)864.72±2.19.58±4.66<.0001*Platelet count (mean)101283.41±127.06434.7±157.9<.0001*Bilirubin (mean)1011.3±0.83.47±2.24<.0001*Ferritin (mean)99229.51±217.68902.36±1321.9<.0001*Creatinine (mean)1010.89±0.890.71±0.350.0231*GFR (mean)7586.3±36.12117.34±51.310.0152*End Organ DamageRetinopathy %6261.54 (8/13)32.65 (16/49)0.0573N, number of patients tested or values reported; MCV, mean corpuscular volumeExcludes 17 patients with Sβ+/SHPFH/other, not included in the comparison because of the small numbers.*Statistically significant at significance level 0.05 ConclusionsOur study highlights the various differences in the prevalence of sickle cell disease-related end organ damage and morbidity among different age, gender and two major sickle cell disease categories. It shows the significant progression of organ damage with advancing age and the more severe nature of SS/Sβ0 phenotype. Further expansion of this assessment may help identify specific high risk groups that can be targeted as candidates for more intensive preventive interventions. Disclosures:No relevant conflicts of interest to declare.

Prevalence and Predictors of Chronic Organ Damage in Adults with Sickle Cell Disease.

Abstract 4624 IntroductionSickle cell disease (SCD) affects about 80,000 individuals in the US and about 1 of every 400 African Americans. Although SCD is characterized by acute painful crisis events, pain rates are a weak indicator of mortality risk. The main determinants of early mortality in adults are painless events such as sickle cell nephropathy (SCN), stroke due to cerebrovascular disease (CVD) and pulmonary hypertension (PHT). Sickle cell retinopathy (SCR) is a common cause of morbidity. There is a powerful correlation between end organ damage and early mortality. The prevalence of preclinical target organ damage has not been fully elucidated. We examined the prevalence of the full spectrum of end organ damage in a cohort at entry to our adult SCD program. We also contrasted the clinical and laboratory characteristics of patients with and without organ dysfunction. Patients and MethodsRetrospective review of data on 118 adults (mean age 26.48±11.85 years) gathered upon entry into our program between February 2005 and October 2008. Historical presence of episodes of acute chest syndrome, pneumonia, stroke, avascular necrosis, osteomyelitis, leg ulcers, priapism, and cholecystectomy was quantitated. All patients underwent a standardized battery of tests to evaluate hematological and biochemical parameters at entry. Objective evidence of end organ damage was defined as follows: PHT, tricuspid regurgitant jet velocity (TRJV) ≥2.5 on echocardiography; SCN, glomerular filtration rate (GFR) < 90ml/min. and/or 24-hour protein>300mg and/or urine protein/creatinine ratio>0.3, all measured or calculated from 24 hour urine sample; CVD, evidence of previous ischemic and/or hemorrhagic infarct and/or aneurysmal dilatation on brain MRI or MR angiogram; SCR, background to proliferative retinopathy on fluorescent retinal angiography. Characteristics of patients were evaluated using t-test for continuous and the chi-square test for the categorical variables. ResultsThere were 58 (49%) males and 60 (51%) females (p-value 0.85). Hemoglobin genotype: 74(63%) had SS/Sβ0, 27(23%) had SC, 11(9%) had Sβ+ while 5(4%) had S/hereditary persistence of fetal hemoglobin (S/HPFH).Of the patients who were tested for individual end organ damage 26% (24/91) had PHT, 52% (48/92) had nephropathy, 40% (31/78) had CVD while 38% (26/68) had retinopathy. The relevant statistically significant correlative variables for each type of end organ damage are shown in the table:End Organ damagePresentAbsentp-valuePHT [26% (24/91)]BNP (mean)85.01±154.0530.93±44.350.01SCN [52% (48/92)]Presence of CVD %51.28250.02Pneumonia (mean no. of episodes)1.71±2.290.80±1.130.0165Reticulocyte count (mean)8.63±5.546.53±3.560.04Platelet count (mean)413.75±167.95326.11±161.470.01BNP (mean)60.4±116.9324.23±19.850.04CVD [40% (31/78)]Age (years, mean)30.63±14.0124.3±10.70.03Presence of nephropathy %68.9741.300.02WBC (mean)11.58±4.849.27±4.270.03Ferritin (mean)1087.12±1701.97393.27±600.780.04SCR [38% (26/68)]Age (years, mean)34.47±14.8522.07±8.66<0.001Presence of leg ulcers %26.924.760.01Cholecystectomy %57.6930.960.03GFR (mean)91.9±37.49119.52±52.790.03Serum creatinine (mean)0.91±0.420.66±0.230.01BNP, brain natriuretic peptide; WBC, white blood cell count ConclusionsEnd organ damage was highly prevalent in this cohort of adults with SCD. Objective clinical and laboratory factors may predict the risk for end organ damage. This information can be used to develop an objective scoring system for disease severity based on early organ damage which may enable identification of patients at highest risk for severe morbidity and early mortality who might be candidates for more intensive evaluation and early management with disease-modifying interventions, beyond treatment of acute painful events. Disclosures:No relevant conflicts of interest to declare.

Alcohol Consumption and Kidney Function in IgA Glomerulonephritis

Background: IgA glomerulonephritis (IgAGN) is a kidney disease with variable prognosis. Several known risk factors exist for a more progressive course. Some population studies indicate that moderate alcohol consumption might protect kidney function, but the relationship between alcohol intake and IgAGN has not previously been examined. Methods: We examined 158 (95 men) IgAGN patients (37 abstainers, 80 light drinkers, 25 moderate drinkers and 16 heavy drinkers) in a cross-sectional study. The definition of alcohol consumption was based on interviews on the amounts of alcohol intake combined with measurements of serum carbohydrate-deficient transferrin, a specific biomarker of alcohol abuse. Longitudinal data on renal function were available from 117 patients (76 men) in whom an analysis with respect to progression was also performed. Results: Moderate drinkers showed the best kidney function. When adjusted by hypertension and 24-hour protein excretion, moderate alcohol consumption in a cross-sectional multivariate analysis, and both light and moderate alcohol consumption in a longitudinal multivariate analysis were significant factors of better kidney function. When the study population was divided by gender, the best kidney function was among light drinkers in women and among moderate drinkers in men. Conclusions: Moderate alcohol consumption might have a favorable impact on the progression of IgAGN. Light alcohol consumption in women and moderate consumption in men are associated with improved indices of the glomerular filtration estimates in patients with IgAGN.

Observation On the Curative Effect of Tangshentongbao Decoction Combined Benazepril on 31Cases of Diabetic Nephropathy in Clinical Stage

Objective To assess the protective effect of Tangshentongbao decoction combined benazepril on renal function of the patients with diabetic nephropathy(DN) in clinical stage and to make a effective contrast to the therapy with western medicine. Methods 62 patients with DN in clinical stage were randomly divided into a control group and a treatment group, with 31 patients in each group. Both groups were supplied with the same food, adopted glucose control therapy and symptoms orientated treatment. On these basis, the treatment group was administered with Tangshentongbao decoction combined benazepril, and the control group was taken kallikrein enteric tablet combined benazepril. The therapeutic courses for both groups were 8 months. The changes of symptoms and physical signs, 24-hour urinay protein (24hUpro), serum cteatimine (SCr), serum creatinine clearance erate (CCr) , blood urea nitrogen (BUN), triglyceride (TG), cholesterd (CHO) and low density lipoprotein-cholesterol (LDL-C)of the two groups were separately assessed. Results 24hUpro, SCr, TG, CHO and LDL-C of treated group were all reduced after the treatment (P<0.01 or P <0.05), showing significant difference compared with the control group. Conclusion 24hUpro and SCr of patients with DN in clinical stage can be evidently reduced by Tangshentongbao decoction, and the effect of reducing blood lipid is remarkable better than western medicine alone. Key words: Diabetic nephropathy in clinical stage; Kidney function; Blood lipid; Tangshentongbao decoction; Benazepril

Clinical profile of patients having pulmonary tuberculosis and renal amyloidosis

Objectives:This study was planned to define the clinical profile of pulmonary tuberculosis (PTB) patients having renal amyloidosis, to identify the factors responsible for development of amyloidosis, to detect the time period between onset of amyloidosis and PTB, and analyze clinical features of amyloidosis in PTB patients for early diagnosis and timely assessment.Materials and Methods:Patients of PTB having pedal edema, proteinuria, and grossly diseased kidneys on ultrasound abdomen were subjected to renal biopsy and appropriate biochemical investigations. Clinical profile of biopsy proven amyloidosis cases was analyzed.Results:There were 43 patients (32 males, 11 females, age range 20–65 years) having PTB with pedal edema, proteinuria, and renal medical disease on abdominal ultrasound where amyloidosis was confirmed by renal biopsy. The total duration of illness ranged from two months to seven years (mean 2.25 years) and was less than five years in 93% patients. All patients had significant proteinuria. Nephrotic syndrome was seen in 23, hypertension in 19, hypoalbuminemia in 33, hypercholesterolemia in 29, and deranged renal functions in 32 patients. Ninety percent patients had moderate to far advanced pulmonary lesions on chest radiography with smear positivity in 21 patients.Conclusions:Renal amyloidosis is an important complication of PTB and should be suspected clinically in patients presenting with a triad of pedal edema, proteinuria, and medical renal disease on ultrasound. Contrary to general belief, renal amyloidosis may occur in PTB patients having disease for relatively shorter duration, and even if adequately treated.

Preventive and therapeutic effects of Yishen Huanji Decoction on kidney injury in rats induced by simulation of military overtraining

To observe the preventive and therapeutic effects of Yishen Huanji Decoction (YSHJD), a compound traditional Chinese herbal medicine, on military overtraining-induced kidney injury in a rat model. Thirty SD rats were randomly divided into normal control group, untreated group and YSHJD-treated group. The military overtraining-induced kidney injury in rats was established by forcing to run on the treadmill for 8 weeks. The rats in YSHJD-treated group were administered with YSHJD at the same time. The 24-hour urines were collected every weekend for detecting the contents of urinary sediment, 24-hour urine total protein, 24-hour urine albumin and activity of N-acetyl-beta-D-glucosaminidase (NAG). The blood and renal tissues were collected after 8-week training, and the levels of serum urea nitrogen (BUN) and creatinine (SCr) were detected. Angiotensin II (Ang II) was detected by radioimmunoassay and activity of Na(+), K(+)-ATPase in kidney was analyzed by chemical colorimetric method. Compared with the normal control group, after 8-week training, the contents of 24-hour urine protein, activities of NAG in urine, and the levels of BUN and SCr in rats in the untreated group and YSHJD-treated group were obviously increased (P<0.05), and these parameters of the YSHJD-treated group were lower than those of the untreated group (P<0.05). The contents of Ang II in blood plasma and kidney of rats in the untreated group and YSHJD-treated group were higher than those of the normal control group (P<0.05), and had no statistical difference between the untreated group and YSHJD-treated group. Compared with the normal control group, the activity of Na(+), K(+)-ATPase in kidney of rats in the untreated group was obviously decreased (P<0.05), and had no statistical difference between the normal control group and YSHJD-treated group. YSHJD can protect against military overtraining-induced kidney injury in rats by decreasing the contents of 24-hour urine protein, BUN and SCr, and the activity of NAG, and increasing the activity of Na(+), K(+)-ATPase.

Dietary Counseling Versus Dietary Supplements for Malnutrition in Chronic Pancreatitis: A Randomized Controlled Trial

Up to 50% of patients with chronic pancreatitis (CP) are malnourished. There are limited data on the role of dietary intervention in improving the nutritional status of such patients. The aim was to compare the efficacy of medium chain triglyceride (MCT)-enriched commercial dietary supplements with dietary counseling for homemade food in the management of malnutrition in patients with CP. In a randomized controlled trial, consecutive undernourished patients with CP (body mass index [BMI] <18.5 kg/m(2)) at a tertiary care hospital were randomized to receive either dietary counseling for regular homemade food or commercial MCT-enriched dietary supplements for a period of 3 months to compensate for the dietary calorie deficit. All patients received standard management for CP including pancreatic enzyme supplements. Primary outcome measure was improvement in BMI. Sixty malnourished patients with CP were randomized to counseling group (n = 29; mean age, 32 +/- 10 years; male, 83%) and supplementation group (n = 31; mean age, 28 +/- 10 years; male, 84%). BMI increased in both the counseling group and supplementation group (17.2 +/- 1.7 vs 18.1 +/- 1.8 kg/m(2), P = .001; 16.7 +/- 1.6 vs 18.2 +/- 1.6 kg/m(2), P = .001). There were similar improvements in triceps skinfold thickness, dietary intake, fecal fat, and pain score during a period of 3 months in both groups. There was, however, no significant difference between the counseling and supplementation groups with regard to any of the outcome measures. Dietary counseling for a balanced homemade diet is as good as commercial food supplements in improving malnutrition in patients with CP.

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor

Protein:Creatinine Ratio in Random Urine Samples Is a Reliable Marker of Increased 24-Hour Protein Excretion in Hospitalized Women with Hypertensive Disorders of Pregnancy

The protein:creatinine ratio in random, untimed urine samples correlates with 24-h protein excretion in pregnant women with and without hypertension. Nevertheless, whether this ratio is appropriate as a screening test for proteinuria is still unclear, in part because of the paucity of large studies. We measured protein:creatinine ratios in random urine samples and protein contents of 24-h urine samples in a cross-sectional study of 927 hospitalized pregnant women at >/=20-weeks of gestational age and in a 2nd cohort of 161 pregnant women. In the 2nd group, urine specimens were obtained before and after completion of the 24-h collections, avoiding 1st-morning void specimens. Protein excretion was >/=300 mg/24 h in 282 patients (30.4%). The urine protein:creatinine ratio and the 24-h protein excretion were significantly correlated (r = 0.98, P <0.001). The protein:creatinine ratio as an indicator of protein excretion >/=300 mg/24 h was >/=0.3. The sensitivity and specificity were 98.2% and 98.8%, respectively. Positive and negative predictive values were 97.2% and 99.2%, respectively, and positive and negative likelihood ratios were 79.2 and 0.02, respectively. The diagnostic accuracy of the urinary protein:creatinine ratio was corroborated in the 2nd cohort of patients, which also showed no statistically significant difference in protein:creatinine ratio between samples obtained >24 h apart. Random urinary protein:creatinine ratio is a reliable indicator of significant proteinuria (>300 mg/day) in nonambulatory pregnant women, irrespective of sampling time during the daytime. The protein:creatinine ratio may be reasonably used as an alternative to the 24-h urine collection method.

Effects of Continuous Positive Airway Pressure on Early Signs of Atherosclerosis in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is associated with adverse cardiovascular outcomes, including myocardial infarction and stroke. Atherosclerosis is a key mechanism for these cardiovascular events. Recent cross-sectional studies showed the presence of early signs of atherosclerosis in patients with OSA who were free of comorbidities. To determine the impact of treatment with continuous positive airway pressure (CPAP) on atherosclerosis. We randomly assigned 24 patients with severe OSA (age, 46 +/- 6 yr) who were free of comorbidities to receive no treatment (control, n = 12) or CPAP (n = 12) for 4 months. Carotid intima-media thickness, arterial stiffness (evaluated by pulse-wave velocity), carotid diameter, 24-hour blood pressure monitoring, C-reactive protein, and catecholamines were determined at baseline and after 4 months. At baseline, all measurements were similar in both groups and did not change in the control group after 4 months. In contrast, a significant decrease occurred in carotid intima-media thickness (707 +/- 105 vs. 645 +/- 95 microm, P = 0.04), pulse-wave velocity (10.4 +/- 1.0 vs. 9.3 +/- 0.9 m/s, P < 0.001), C-reactive protein (3.7 +/- 1.8 vs. 2.0 +/- 1.2 mg/L, P = 0.001), and catecholamines (365 +/- 125 vs. 205 +/- 51 ng/ml, P < 0.001) after 4 months of CPAP. Carotid diameter did not change significantly. Regarding the whole group, changes in carotid intima-media thickness were correlated with changes in catecholamines (r = 0.41, P < 0.05). Changes in pulse-wave velocity were correlated with changes in C-reactive protein (r = 0.58, P < 0.01) and catecholamines (r = 0.54, P < 0.01). The treatment of OSA significantly improves early signs of atherosclerosis, supporting the concept that OSA is an independent risk factor for atherosclerosis. Clinical trial registered with www.clinicaltrials.gov (NCT 00400543).

Dietary Protein Requirements and Dialysate Protein Losses in Chronic Peritoneal Dialysis Patients

Recommended dietary protein allowances for chronic peritoneal dialysis (PD) patients are approximately 60% higher than the dietary protein allowances for healthy adults. The relative contribution of dialysate protein and amino acid losses to these high protein requirements or total nitrogen losses is uncertain. Following a peritoneal equilibration test, two 24-hour dialysate collections (24-1 and 24-2) were performed in 9 stable patients undergoing automated PD [4 males, 3 diabetics, age 43 +/- 5 years (mean +/- SEM), dialysis vintage 42 +/- 6 months, dialysate-to-plasma ratio of creatinine 0.61 +/- 0.04]. Dialysate effluent from nighttime cycling was collected separately from the daytime dwells. The measured 24-hour protein losses were 9.4 +/- 0.6 (24-1) and 10.8 +/- 0.8 (24-2) g/day. Even though day dwells accounted for 27% of daily dialysate volume, they accounted for 40% of daily protein and amino acid losses. The frequency of nighttime cycling and duration of dwell were significant predictors of peritoneal protein losses. Dialysate protein and amino acid losses constituted 24% +/- 2% and 3.1% +/- 0.3% of dialysate nitrogen and 14% +/- 1% and 1.7% +/- 0.1% of dietary nitrogen intake respectively. Treatment with automated PD is associated with somewhat higher 24-hour dialysate protein losses compared to previous reports among continuous ambulatory PD patients. Dialysate protein and amino acid losses constitute a small, albeit significant, proportion of total nitrogen appearance and thus may contribute to the increased dietary protein requirements of chronic PD patients.

Evaluation of Proteinuria in Healthy Living Kidney Donor Candidates

Background Evaluation of living kidney donor candidates includes careful assessment for the presence or absence of kidney disease. Kidney donation has been considered to be at least relatively contraindicated if urinary total protein excretion is above the normal range. However, at the present time, there is no uniformly accepted level of urine total protein excretion that would exclude donation. Albumin excretion instead of total protein excretion as a criterion has not previously been evaluated. Materials and methods This was a prospective observational study over a 3-year period in a single tertiary care center designed to assess current selection criteria for kidney donation with respect to urine total protein and albumin excretion. Results Twenty four percent (25 of 105) of healthy adult kidney donor candidates had elevated urinary total protein excretion rates (150 to 292 mg/24 h). Of these 105 candidates, 39 had simultaneous measurements of both urinary total protein and albumin. Although one-third (13/39) had elevated 24-hour urine total protein values, none had elevated urine albumin excretion. Conclusion Measurement of albumin, the most common single protein found in urine, appears to be helpful in the evaluation of proteinuria in donor candidates. Many healthy adult kidney donor candidates have mildly elevated total protein excretion but normal albumin excretion. We believe that such patients should not be excluded from donation.

Follow-up of combined intervention for patients with both renal and cerebral artery stenosis

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