Urinary Urea Nitrogen Research Articles

Effect of pearl millet silage ammoniated with urea on lamb production and metabolic performance

AbstractThe objective of this study was to determine the effect of diets containing pearl millet silage ammoniated with urea on the intake, digestibility, production performance, and nitrogen metabolism of lambs. Thirty‐two uncastrated mixed‐breed lambs at 4 to 5 months of age, with an average initial body weight of 17.39 ± 2.16 kg, were distributed into four treatments in a randomized block experimental design with eight replicates. Experimental diets consisted of pearl millet silage ammoniated with urea during ensiling at the levels of 0, 20, 40, and 60 g/kg dry matter (DM). Increasing urea levels in the pearl millet silage led to a linear decrease (p < .05) in the intakes of DM, organic matter, and total digestible nutrients by the lambs. Total and average daily weight gains decreased linearly (p < .05) with the addition of urea to the silage. Intake and digestibility of crude protein, nitrogen intake, urine urea nitrogen, plasma urea nitrogen, microbial synthesis, and microbial efficiency had a quadratic response (p < .05) to the urea levels in the silage. Pearl millet silage ammoniated with urea reduces dry‐matter intake and daily weight gain in lambs. Urea is not recommended for use in the ensiling of pearl millet.

Low Protein Intake in the Population: Low Risk of Kidney Function Decline but High Risk of Mortality

This population-based study investigated low protein intake, mortality, and kidney function decline. Observational longitudinal cohort study. Target cohort consisted of 4,679 adults participating in 1988-1992 and 2001-2007 examinations of the Gubbio Study (baseline and follow-up). Data collection included overnight urine urea nitrogen (UUN) and other variables at baseline, serum creatinine at baseline and follow-up, and mortality from baseline to follow-up. Three hundred seventy-two persons were excluded for missing data. UUN in the lowest 20% of the distribution was defined as low and used as index of low protein intake. Estimated glomerular filtration rate (eGFR, mL/minute × 1.73m2) was used as kidney function index. None (observational study). Mortality and eGFR decline are the main outcome measures, and eGFR decline was defined as eGFR change from baseline to follow-up≤mean-1 standard deviation (Z-score≤ -1). Eight hundred seventy-one deaths occurred over 15.9±4.0years of observation (417 from cardiovascular disease and 276 from neoplastic disease). Low UUN associated with mortality (hazard ratio, HR = 1.31, 95% confidence interval, CI = 1.12/1.53) due to association with mortality from neoplastic disease (HR = 1.33, 95% CI = 1.02/1.76). Mortality-corrected follow-up response rate was 79.9% (n=2845). Baseline to follow-up eGFR change was -9.9±10.1, and eGFR decline was found in 454 examinees. Low UUN associated with eGFR decline only in subgroup with baseline eGFR <90 (n=1441, odds ratio=0.44, 95% CI=0.22/0.85). Low baseline eGFR interacted with the association between low UUN and eGFR decline (P=.024). Low protein intake predicted higher mortality in the whole population and lower incidence of eGFR decline only in subgroup with reduced kidney function.

Uric acid upregulates the adiponectin‑adiponectin receptor1 pathway in renal proximal tubule epithelial cells.

Adiponectin (APN) is a protein hormone that is primarily derived from adipocytes. It can also be secreted by renal cells. Hypoadiponectinemia has been documented in patients with hyperuricemia, however, whether soluble uric acid (SUA) regulates the expression of APN and APN receptor 1 (AdipoR1) in renal proximal tubule epithelial cells (PTECs) remains to be elucidated. The present study investigated the expression of APN and AdipoR1 in cultured PTECs that were exposed to SUA through immunofluorescence and western blot analysis. In addition, Sprague-Dawley rats with oxonic acid-induced hyperuricemia (HUA) with or without febuxostat treatment were employed as an animal model to measure 24 h urine protein, serum creatinine, urea nitrogen, uric acid and homeostasis model assessment of insulin resistance. Renal pathology was evaluated using hematoxylin and eosin and immunohistochemical staining. APN and AdipoR1 expression in the renal cortex were evaluated by western blotting. The results demonstrated that, in PTECs, the expression of APN and AdipoR1 was constant and increased upon SUA exposure. Similar observations were made within the proximal renal tubules of rats, and the oxonic acid-induced increases in APN and AdipoR1 were offset by febuxostat treatment. Furthermore, SUA-treated PTECs exhibited an increase in the expression of NLR family pyrin domain-containing (NLRP) 3, which was dose-dependent. NLRP3 expression was also significantly increased in the renal cortex of HUA rats compared with control and febuxostat-treated rats. In conclusion, SUA enhanced the expression of APN and AdipoR1 in PTECs, which was associated with an increase in NLRP3 expression. The APN-AdipoR1 pathway was demonstrated to have an important role in in vitro and in vivo models of renal proximal tubule inflammatory injury. Therefore, this pathway may be a potential therapy target in urate nephropathy.

Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single-Dose 15 N Glycine Stable Isotope Protocol With End-Product Enrichment.

We used the 15 N glycine urinary end-product enrichment technique to quantify whole body protein turnover following thoracic surgery. A single dose of 15 N glycine (2 mg/kg) was administered orally on postoperative day 1 to children (1-18 years) following thoracic surgery. 15 N enrichment of ammonia and urea was measured in mixed urine after 12 and 24 hours, respectively, and protein synthesis, breakdown, and net balance determined. Nitrogen balance (dietary intake minus urinary excretion) was calculated. Urinary 3-methylhistidine:creatinine ratio was measured as a marker of skeletal muscle protein breakdown. We enrolled 19 subjects-median (interquartile range): age, 13.8 years (12.2-15.1); weight, 49.2 kg (38.4-60.8)-who underwent thoracotomy (n = 12) or thoracoscopic (n = 7) surgery. Protein synthesis and breakdown by 15 N enrichment were 7.1 (5.5-9) and 7.1 (5.6-9) g·kg-1 ·d-1 with ammonia (12 hours) as the end product, and 5.8 (3.8-6.7) and 6.7 (4.5-7.6) with urea (24 hours), respectively. Net protein balance by the 15 N glycine and urinary urea nitrogen methods were -0.34 (-0.47, -0.3) and -0.48 (-0.65, -0.28) g·kg-1 ·d-1 , respectively (rs = 0.828, P < .001). Postoperative change in 3-methylhistidine:creatinine ratio did not correlate significantly with protein breakdown or balance. The single-dose oral administration of 15 N glycine stable isotope with measurement of urinary end-product enrichment is a feasible and noninvasive method to investigate whole body protein turnover in children. After major surgery, children manifest increased protein turnover and net negative balance due to increased protein breakdown.

Increased serum C‐reactive protein and decreased urinary aquaporin 2 levels are predictive of the efficacy of tolvaptan in patients with liver cirrhosis

Water retention, hepatic ascites, and peripheral edema are significant problems in patients with liver cirrhosis (LC). Although furosemide and spironolactone are commonly used as treatment, they are often insufficient to treat hyponatremia and renal insufficiency in patients with LC. Tolvaptan (TVP) could provide an effective treatment alternative. However, predictive factors of a therapeutic response to TVP are unclear. Our aim was to examine clinical predictors of the response to TVP in patients with LC and water retention. Fifty-two patients were treated with TVP, with therapeutic effects judged by a decrease in body weight (≥2kg) and increase in urinary volume (≥500mL) within 7days. Blood biochemical tests were carried out at baseline and post-treatment, including serum soluble CD14 (sCD14) and urinary aquaporin 2 (AQP2) levels. Clinical and laboratory predictive factors of a TVP response were evaluated by univariate and multivariate analyses. The overall response to TVP was 55.8%. On univariate analyses, serum C-reactive protein (CRP) level, the neutrophil-to-lymphocyte ratio, urinary blood urea nitrogen, and urinary AQP2 were predictors of the TVP response, with only serum CRP retained on multivariate analysis. A higher serum sCD14 level was strongly associated with a non-response to TVP. A decrease in urinary AQP2 to undetectable level was associated with a response. Tolvaptan provides a rapid and strong effect to improve water retention in patients with LC. Baseline serum sCD14 and CRP levels are useful predictors of a response to TVP, with a decrease in urinary AQP2 during treatment indicating an early response.

The preliminary analysis of protein catabolism and nitrogen balance in young gymnasts

Summary Objectives The use of proper diet in athletes is one of the most important elements of sports training. Moreover, the essentials in planning diet for athletes among other things should be taken into account: energy balance, the nutritional value of meals and supplements of diet. The main aim of this study was to estimate the level of whole body proteins catabolism, nitrogen and energy balance in young gymnasts. Methods In the present study participated young gymnastics (13.0 ± 0.5 year), which have been trained artistic gymnastics since 6.8 ± 0.45 year. The investigation contained two times measuring urea in 24 h urine collection, measuring energy expenditure indirect method by 24 h monitoring heart rate, and supplementation by 7 days products contain protein and carbohydrate. Results Concentration of urea nitrogen in urine at the first test before supplementation was 8.0 ± 0.75 g/d. The energy expenditure in young boys before supplementation was negative (−915 ± 130 kcal). The concentration of urea nitrogen was lower in 4 out of 5 examined boys as compared to the first test after supplementation. The difference between the level of nitrogen balance output and the level after supplementation was statistically significant (P ≤ 0.05). Conclusion The supplementation with proteins and carbohydrates products immediately after training may lead to decrease concentration of urea nitrogen and whole body protein catabolism. Monitoring energy expenditure, food nutrients, and calories in diet during and after training should be an integral part of planning for long-term training program.

Attenuation of STZ-induced diabetic nephropathy byCucurbita pepoL. seed extract characterized by GCMS

The present study was aimed to evaluate the potential of petroleum ether and hydro-alcoholic extract of Cucurbita pepo (CPE and CHE) in STZ-induced diabetic nephropathy. GC-MS analysis of CPE revealed the presence of different fatty acids, heterocyclic compounds, and so on. Diabetes was induced by intraperitoneal administration of STZ (65 mg/kg) for the development of diabetic nephropathy. After 30 days of STZ-administration, 100, 200, and 400 mg/kg of CPE and CHE were administered for 45 days. CPE and CHE significantly increased body weight, lowered blood glucose levels, and ameliorated kidney hypertrophy index in the STZ-diabetic rats. The extract also decreased the levels of creatinine, blood urea nitrogen, total cholesterol, triglycerides, AGEs and albumin in urine, respectively. The results indicated that via amelioration oxidative stress and formation of AGEs, C. pepo produced significant nephroprotective effect in STZ- induced diabetic nephropathy in rats. Practical applications DN is a syndrome mainly characterized as increase in excretion of urine albumin, urea, uric acid, and creatinine; glomerular lesions and reduce glomerular filtration rate (GFR) in diabetics. Fruit and seeds of Cucurbita pepo have significant hypoglycemic and antioxidant activity. C. pepo possesses antioxidant, antihyperglycemic, antihyperlipidemic, and antiglycation activity and thus, exhibits a protective action in STZ-induced diabetic nephropathy. Moreover, further work is necessary to elucidate in detail the mechanism of action of C. pepo at the cellular and molecular levels.

Nitrogen Balance and Its relation with Energy and Protein Intake in Criticaly Ill Elderly Patients

Introduction:Nitrogen balance in criticaly ill patients has the tendency to be negative due to stress response. In the elderly patients, the metabolic changes risk to worsening nitrogen balance. The aim of this study was to determine nitrogen balance and its correlation with energy and protein intake in critically ill elderly patients within 48 hours in ICU.Methods: The method was cross sectional, consecutive sampling on 26 critically ill elderly subjects. Inclusion criteria were patients admitted to ICU, age &gt;60 years old, male/female, whose family/relatives agreed to join this study. Patients who had urine output &lt;0,5 mL/kg/hours were excluded. Data collected were energy and protein intake, urinary urea nitrogen (UUN), and nitrogen balance during 24 hours I and II of admission.Results: The median age was 70 (61 – 85) years old, body mass index was 22. 9 ­+ 2.7 kg/m2, most of the subjects were surgical patients. In 24 hours I and II, the nitrogen balances were -5.2 (-31.2 − -4.1) and -4.5 + 4.6 respectively, energy intakes were not significantly different; 78.8 + 45.0% and 91.1 + 50.2% respectively, and protein intakes were significantly different; 34.1 + 19.3 g/d and 41.2 + 21.3 g/d respectively. There was positive correlation between nitrogen balance and energy intake; r=0.6 and r=0.5, and also between protein intake; r=0.5 and r=0.4, in 24 hours I and II respectively.Conclusion: There were significantly positive correlation between nitrogen balance with energy and protein intake.

268 Environmental impacts from cattle consuming tannin-containing hays

The cow-calf phase accounts for approximately 80% of total greenhouse gas emissions attributed to beef production systems. There is potential for tannin-containing hays to reduce these environmental impacts. Fifteen mature beef brood cows and 9 yearling beef heifers were blocked by weight and randomly assigned to 3 groups of 5 cows or 3 heifers and fed tannin-containing (bird's-foot trefoil-BFT, sainfoin-SAN, small burnet-SML) or non-tannin-containing (alfalfa-ALF, cicer milkvetch-CMV, meadow bromegrass-MB) hays in 4 trials. Groups of cows were fed BFT, CMV, or MB in Trial 1 and ALF, SAN, or SML in Trial 3. Groups of heifers were fed ALF, MB, or SAN in Trial 2 and BFT, CMV, or SML in Trial 4. Each trial used a completely randomized block design with repeated measures during 5 days following a 14-d adjustment period. Nine cows and 9 heifers were selected for total collection of enteric methane using the SF6 methodology, feces, and urine while intake was measured for all animals. Methane emission from cows was lower for SML than ALF (P = 0.04) or SAN (P = 0.03; Table 268). Additionally, cows and heifers fed tannin-containing hays had lower urine urea nitrogen (UUN) and blood urea nitrogen (BUN) than animals fed non-tannin-containing hays (Table 268), suggesting a shift in nitrogen excretion from urine to feces. In conclusion, tannin-containing legumes consumed as hays have the potential to reduce environmental impacts attributed to cattle fed in confinement. a-cMeans in a row with different superscripts differ (P < 0.1). a-cMeans in a row with different superscripts differ (P < 0.1).

Acid Load and Phosphorus Homeostasis in CKD

The kidneys maintain acid-base homeostasis through excretion of acid as either ammonium or as titratable acids that primarily use phosphate as a buffer. In chronic kidney disease (CKD), ammoniagenesis is impaired, promoting metabolic acidosis. Metabolic acidosis stimulates phosphaturic hormones, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) invitro, possibly to increase urine titratable acid buffers, but this has not been confirmed in humans. We hypothesized that higher acid load and acidosis would associate with altered phosphorus homeostasis, including higher urinary phosphorus excretion and serum PTH and FGF-23. Cross-sectional. 980 participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Net acid excretion as measured in 24-hour urine, potential renal acid load (PRAL) estimatedfrom food frequency questionnaire responses, and serum bicarbonate concentration< 22 mEq/L. 24-hour urine phosphorus and calcium excretion and serum phosphorus, FGF-23, and PTH concentrations. Using linear and log-linear regression adjusted for demographics, kidney function, comorbid conditions, body mass index, diuretic use, and 24-hour urine creatinine excretion, we found that 24-hour urine phosphorus excretion was higher at higher net acid excretion, higher PRAL, and lower serum bicarbonate concentration (each P<0.05). Serum phosphorus concentration was also higherwith higher net acid excretion and lower serum bicarbonate concentration (each P=0.001). Only higher net acid excretion associated with higher 24-hour urine calcium excretion (P<0.001). Neither net acid excretion nor PRAL was associated with FGF-23 or PTH concentrations. PTH, but notFGF-23, concentration (P=0.2) was 26% (95% CI, 13%-40%) higher in participants with a serumbicarbonate concentration<22 versus≥22 mEq/L (P<0.001). Primary results were similar if stratified by estimated glomerular filtration rate categories or adjusted for iothalamate glomerular filtration rate (n=359), total energy intake, dietary phosphorus, or urine urea nitrogen excretion, when available. Possible residual confounding by kidney function or nutrition; urine phosphorus excretion was included in calculation of the titratable acid component of net acid excretion. In CKD, higher acid load and acidosis associate independently with increased circulating phosphorus concentration and augmented phosphaturia, but not consistently with FGF-23 or PTH concentrations. This may be an adaptation that increases titratable acid excretion and thus helps maintain acid-base homeostasis in CKD. Understanding whether administration of base can lower phosphorus concentrations requires testing in interventional trials.

Higher protein intake is associated with improved muscle strength in elite senior athletes.

The optimal protein intake for elderly individuals who exercise regularly has not yet been clearly defined. The aim of this study was to test the hypothesis that protein intake level is associated with muscle strength in elderly elite athletes. We evaluated 50 elite senior athletes (38 men and 12 women) participating in the European Master Games 2011 in an observational cross-sectional study. Participants were divided into two groups-lower (LPI) or higher (HPI) protein intake-according to the median value of their ratio of urinary urea nitrogen to urinary creatinine (i.e., 8.8g/L), as a marker of protein intake. A dietary interview confirmed differences in protein consumption between the LPI and HPI groups. We also evaluated body composition (bioimpedance), muscle strength, and hematochemical indices. LPI and HPI groups were homogeneous for age (72 [68-74] and 71 [68-74] y, respectively), fat-free mass index (18.4 [17-19.4] and 18.2 [17-19.1] kg/m2), body fat (18.3% [12.3-20.7%] and 16.6% [13.6-21.2%]), and glomerular filtration rate (57.7 [53.8-64.9] and 62.7 [56.1-69.3] mL/min/1.73m2). The HPI group showed greater leg and trunk muscle strength (N) compared with the LPI group (left leg extension, 339 [238-369] versus 454 [273-561], respectively, P<0.05; right leg extension, 319 [249-417] versus 432 [334-635], P≤0.05; trunk extension, 435 [370-467] versus 464 [390-568], P≤0.05). Higher protein intake in elite senior athletes is associated with a greater muscle strength.

How to assess the efficacy of phosphate binders

Background and aimsThe efficacy of phosphate binders is difficult to be estimated clinically. This study analyzes the changes in serum phosphate and urinary phosphate excretion after the prescription of phosphate binders (PB) in patients with chronic kidney disease stage 4–5 pre-dialysis, and the usefulness of the ratio between total urinary phosphate and protein catabolic rate (Pu/PCR) for estimating the efficacy of PB. MethodsThis retrospective observational cohort study included adult chronic kidney disease patients. Biochemical parameters were determined baseline and after 45–60 days on a low phosphate diet plus PB (“binder” subgroup=260 patients) or only with dietary advice (“control” subgroup=79 patients). ResultsPhosphate load (total urinary excretion) per unit of renal function (Pu/GFR) was the best parameter correlated with serum phosphate levels (R2=0.61). Mean±SD level of Pu/PCR was 8.2±2.3mg of urinary phosphate per each g of estimated protein intake. After treatment with PB, serum phosphate levels decreased by 11%, urinary phosphate 22%, protein catabolic rate 7%, and Pu/PCR 15%. In the control subgroup, Pu/PCR increased by 20%. Urinary phosphate and urea nitrogen excretion correlated strongly, both baseline and after PB or dietary advice. ConclusionsThe proposed parameter Pu/PCR may reflect the rate of intestinal phosphate absorption, and therefore, its variations after PB prescription may be a useful tool for estimating the pharmacological efficacy of these drugs.

Cómo estimar la eficacia de un captor del fósforo

Background and aimsThe efficacy of phosphate binders is difficult to be estimated clinically. This study analyzes the changes in serum phosphate and urinary phosphate excretion after the prescription of phosphate binders (PB) in patients with chronic kidney disease stage 4-5 pre-dialysis, and the usefulness of the ratio between total urinary phosphate and protein catabolic rate (Pu/PCR) for estimating the efficacy of PB. MethodsThis retrospective observational cohort study included adult chronic kidney disease patients. Biochemical parameters were determined baseline and after 45-60 days on a low phosphate diet plus PB (“binder” subgroup=260 patients) or only with dietary advice (“control” subgroup=79 patients). ResultsPhosphate load (total urinary excretion) per unit of renal function (Pu/GFR) was the best parameter correlated with serum phosphate levels (R2=0.61). Mean±SD level of Pu/PCR was 8.2±2.3mg of urinary phosphate per each g of estimated protein intake. After treatment with PB, serum phosphate levels decreased by 11%, urinary phosphate 22%, protein catabolic rate 7%, and Pu/PCR 15%. In the control subgroup, Pu/PCR increased by 20%. Urinary phosphate and urea nitrogen excretion correlated strongly, both baseline and after PB or dietary advice. ConclusionsThe proposed parameter Pu/PCR may reflect the rate of intestinal phosphate absorption, and therefore, its variations after PB prescription may be a useful tool for estimating the pharmacological efficacy of these drugs.

Assessing fresh urine puddle chemistry in commercial dairy cow houses

Ammonia emission mainly originates from urea in urine puddles on floors in dairy cow houses. This emission process can be modelled. However, required model inputs have not been updated recently. In addition, values for the model variables pH, Urinary Urea Nitrogen concentration (UUN), and their relation with farm and feed management are unknown for commercial dairy cow houses. Moreover, their effect on ammonia emission is unknown. Therefore, the objective of this paper was to investigate the pH and UUN in livestock practice. Sixteen commercial farms were measured in a factorial design of four Floor-Management types (FMTypes). Each farm was measured in two seasons and a Diet factor was defined, based on the amount of grass in total roughage. Overall mean values were 4.27 kg m−3 for UUN, an initial pH of 8.3, both in fresh puddles, and a pH(ξ) of 9.0 for random puddles at a random time. For UUN both the variation within and between farms was large, whereas the variation for pH was small. The Diet was the only factor that resulted in a significant effect, with a 0.1 difference in pH(ξ). Compared to the reference values, both the mean UUN and pH showed smaller values. The calculated potential ammonia in kg puddle−1, however, showed a huge range and was considerably larger than the commonly used reference values in the Netherlands.

The effects of heat stress on protein metabolism in lactating Holstein cows

Heat stress (HS) decreases milk protein synthesis beyond what would be expected based on the concomitant reduction in feed intake. The aim of the present study was to evaluate the direct effects of HS on milk protein production. Four multiparous, lactating Holstein cows (101 ± 10 d in milk, 574 ± 36 kg of body weight, 38 ± 2 kg of milk/d) were individually housed in environmental chambers and randomly allocated to 1 of 2 groups in a crossover design. The study was divided into 2 periods with 2 identical experimental phases (control phase and trial phase) within each period. During phase 1 or control phase (9 d), all cows were housed in thermal neutral conditions (TN; 20°C, 55% humidity) and fed ad libitum. During phase 2 or treatment phase (9 d), group 1 was exposed to cyclical HS conditions (32 to 36°C, 40% humidity) and fed ad libitum, whereas group 2 remained in TN conditions but was pair-fed (PFTN) to their HS counterparts to eliminate the confounding effects of dissimilar feed intake. After a 30-d washout period in TN conditions, the study was repeated (period 2), inverting the environmental treatments of the groups relative to period 1: group 2 was exposed to HS and group 1 to PFTN conditions. Compared with PFTN conditions, HS decreased milk yield (17.0%), milk protein (4.1%), milk protein yield (19%), 4% fat-corrected milk (23%), and fat yield (19%). Apparent digestibility of dry matter, organic matter, neutral detergent fiber, acid detergent fiber, crude protein, and ether extract was increased (11.1-42.9%) in HS cows, as well as rumen liquor ammonia (before feeding 33.2%; after feeding 29.5%) and volatile fatty acid concentration (45.3%) before feeding. In addition, ruminal pH was reduced (9.5 and 6% before and after feeding, respectively) during HS. Heat stress decreased plasma free amino acids (AA; 17.1%) and tended to increase and increased blood, urine, and milk urea nitrogen (17.2, 243, and 24.5%, respectively). Further, HS cows had reduced plasma glucose (8%) and nonesterified fatty acid (39.8%) concentrations compared with PFTN controls. These data suggest that HS increases systemic AA utilization (e.g., decreased plasma AA and increased nitrogen excretion), a scenario that limits the AA supply to the mammary gland for milk protein synthesis. Furthermore, the increase in AA requirements during HS might represent the increased need for gluconeogenic precursors, as HS is thought to prioritize glucose utilization as a fuel at the expense of nonesterified fatty acids.

Permissive Underfeeding or Standard Enteral Feeding in High- and Low-Nutritional-Risk Critically Ill Adults. Post Hoc Analysis of the PermiT Trial.

The optimal nutritional strategy for critically ill adults at high nutritional risk is unclear. To examine the effect of permissive underfeeding with full protein intake compared with standard feeding on 90-day mortality in patients with different baseline nutritional risk. This is a post hoc analysis of the PermiT (Permissive Underfeeding versus Target Enteral Feeding in Adult Critically Ill Patients) trial. Nutritional risk was categorized by the modified Nutrition Risk in Critically Ill score, with high nutritional risk defined as a score of 5-9 and low nutritional risk as a score of 0-4. Additional analyses were performed by categorizing patients by body mass index, prealbumin, transferrin, phosphate, urinary urea nitrogen, and nitrogen balance. Based on the Nutrition Risk in Critically Ill score, 378 of 894 (42.3%) patients were categorized as high nutritional risk and 516 of 894 (57.7%) as low nutritional risk. There was no association between feeding strategy and mortality in the two categories; adjusted odds ratio (aOR) of 0.84 (95% confidence interval [CI], 0.56-1.27) for high nutritional risk and 1.01 (95% CI, 0.64-1.61) for low nutritional risk (interaction P = 0.53). Findings were similar in analyses using other definitions, with the exception of prealbumin. The association of permissive underfeeding versus standard feeding and 90-day mortality differed when patients were categorized by baseline prealbumin level (≤0.10 g/L: aOR, 0.57 [95% CI, 0.31-1.05]; >0.10 and ≤0.15 g/L: aOR, 0.79 [95% CI, 0.42-1.48]; >0.15 g/L: aOR, 1.55 [95% CI, 0.80, 3.01]; interaction P = 0.009). Among patients with high and low nutritional risk, permissive underfeeding with full protein intake was associated with similar outcomes as standard feeding.

Renoprotective effect of fucoidan from Acaudina molpadioides in streptozotocin/high fat diet-induced type 2 diabetic mice

Fucoidan from sea cucumber exerts anti-hyperglycemia and anti-inflammatory effects. However, its renoprotective activities are unclear. In the current study, renoprotective effects of fucoidan from Acaudina molpadioides (Am-FUC) were investigated in type 2 diabetic mice induced by intraperitoneal administration of streptozotocin and high fat diet feeding. Results showed that Am-FUC attenuated renal dysfunction through the decreases in urinary urea nitrogen, albumin, β-N-Acetyl-D-glucosaminidase, and albumin-to-creatinine ratio. In Am-FUC-treated mice, significant reductions in tubular atrophy and glomerular basement membrane thickness were observed. Immunohistological examination revealed that Am-FUC attenuated renal fibrosis. Am-FUC decreased the expression of transforming growth factor-β1 (TGF-β1), plasminogen activator inhibitor 1, and phosphorylated Smad3. Renal oxidative stress and inflammation were also alleviated by Am-FUC treatment. Our data demonstrate that Am-FUC has significantly renoprotective effects through attenuating TGF-β1 signal, which associated with the improvement against hyperglycemia, obesity, oxidative stress and inflammation.

Excretion of faecal, urinary urea and urinary non-urea nitrogen by four ruminant species as influenced by dietary nitrogen intake: A meta-analysis

The quantification of faecal nitrogen (FN) and of urinary urea-N (UUN) and urinary non-urea-N (UNUN) excretion at varying N contents in ruminant rations is an important tool in assessing endogenous N turnover via the rumino-hepatic cycle. Using a statistical analysis based on an extensive database, the aim of this meta-analysis was to evaluate correlations derived previously by deduction. The data were categorised into dairy cattle, growing cattle (bulls and heifers), sheep and goats. Data from 50 publications were considered. The independent variable was the daily N intake (NI, g/day). The dependent variables were the daily quantities (g/day) of FN, urinary N (UN) , UUN, UNUN and N retention. The NI influenced FN to differing extents in goats, dairy cattle, growing cattle and sheep (listed in descending order of influence). Except in sheep, the effect was statistically significant. The influence on UN varied in the order goats, growing cattle, dairy cattle and sheep; the effect was statistically significant only for dairy cattle and growing cattle (P<0.001). The UUN was influenced in the order sheep, goats, dairy cattle and growing cattle (P<0.05). The UNUN could be assessed only in dairy cattle, growing cattle and sheep and was not influenced by NI. The UUN is therefore more strongly dependent on NI than is UNUN and the latter can therefore continue to be seen as obligatory. The FN is indeed influenced by NI but, as a result of higher digestibility of the total ration with increasing crude protein content, an improvement in microbial crude protein synthesis can also be assumed, which is reflected in higher FN levels.

Availability of two self-administered diet history questionnaires for pregnant Japanese women: A validation study using 24-hour urinary markers.

BackgroundAccurate and easy dietary assessment methods that can be used during pregnancy are required in both epidemiological studies and clinical settings. To verify the utility of dietary assessment questionnaires in pregnancy, we examined the validity and reliability of a self-administered diet history questionnaire (DHQ) and a brief-type self-administered diet history questionnaire (BDHQ) to measure energy, protein, sodium, and potassium intake among pregnant Japanese women.MethodsThe research was conducted at a university hospital in Tokyo, Japan, between 2010 and 2011. The urinary urea nitrogen, sodium, and potassium levels were used as reference values in the validation study. For the reliability assessment, participants completed the questionnaires twice within a 4-week interval.ResultsFor the DHQ (n = 115), the correlation coefficients between survey-assessed energy-adjusted intake and urinary protein, sodium, and potassium levels were 0.359, 0.341, and 0.368, respectively; for the BDHQ (n = 112), corresponding values were 0.302, 0.314, and 0.401, respectively. The DHQ-measured unadjusted protein and potassium intake levels were significantly correlated with the corresponding urinary levels (rs = 0.307 and rs = 0.342, respectively). The intra-class correlation coefficients for energy, protein, sodium, and potassium between the time 1 and time 2 DHQ (n = 58) and between the time 1 and time 2 BDHQ (n = 54) ranged from 0.505 to 0.796.ConclusionsBoth the DHQ and the BDHQ were valid and reliable questionnaires for assessing the energy-adjusted intake of protein, sodium, and potassium during pregnancy. In addition, given the observed validity of unadjusted protein and potassium intake measures, the DHQ can be a useful tool to estimate energy intake of pregnant Japanese women.

Urinary kidney injury molecule‑1 as an early diagnostic biomarker of obstructive acute kidney injury and development of a rapid detection method.

The aim of the present study was to investigate whether urinary kidney injury molecule-1 (KIM-1) presents a suitable early diagnostic biomarker of obstructive nephropathy-induced acute kidney injury (AKI), and to develop a rapid detection method for urinary KIM-1. Obstructive AKI was induced in an experimental rat model by a unilateral ureteral obstruction (UUO) operation. Macro- and micromorphological kidney alterations were determined by visual observation and hematoxylin and eosin (HE) staining, respectively. Kidney functions were evaluated by detecting urea nitrogen and creatinine levels in rat urine and blood. Urinary KIM-1 levels were measured using an enzyme-linked immunosorbent assay, and the protein expression levels of KIM-1, α-smooth muscle actin (α-SMA) and vimentin in kidney tissues were detected using immunohistochemical assays. In order to measure KIM-1 levels, colloidal gold immunochromatographic strips were developed based on the colloidal gold immunochromatographic assay. The results indicated that KIM-1 levels were significantly higher in the UUO group when compared with the Sham group. KIM-1 levels in the urine and kidney tissues exhibited a time-dependent increase, together with increasing obstructive AKI in the UUO group. In addition, KIM-1 levels were demonstrated to be a more sensitive biomarker of early obstructive AKI, when compared with α-SMA and vimentin. A colloidal gold-based immunochromatographic strip was developed, whereby the detection of urinary KIM-1 could be completed within 5–10 min. In conclusion, results of the present study demonstrated that urinary KIM-1 may be a valuable biomarker for the early diagnosis of obstructive AKI, and the use of a colloidal gold immunochromatographic strip may be a promising method for the rapid detection of urinary KIM-1.