Early evolution of nutritional status and body composition after kidney transplantation.

BACKGROUND: Previous series have dealt with nutritional status after kidney transplantation. However, few studies have described the outcome of body composition after kidney transplantation. METHODS: A total of 44 cadaver kidney transplant recipients (28 men and 16 women) were followed prospectively during the first post-transplant year. Biochemical nutritional markers, dietary records, anthropometric measurements, and body composition were assessed at kidney transplantation and 3, 6, and 12 months later. RESULTS: By the end of the first year, serum albumin level was not significantly different from initial values. Prealbumin and retinol binding protein decreased from 42.3 +/- 10.2 mg/dL to 30.4 +/- 6.3 mg/dL and from 1.96 +/- 0.61 g/dL to 0.65 +/- 0.2 g/dL (P < 0.0001). Separating patients by gender showed that dietary caloric and protein intake increased in women only. At the end of the follow-up period, mean weight change was +5.4 kg in women (P = 0.009) and -0.9 kg in men (not significant). Body composition analyses showed that in women total fat and lean masses increased (+2.1 kg, P = 0.05, and +2.4 kg, P = 0.006), whereas in men total fat mass decreased (-1.4 kg, P = 0.04), and total lean mass tended to increase (+0.5 kg, not significant). Percentage change in total bone mass was +1.4% in women (not significant) and -2.1% in men (P = 0.05). In multivariate analyses, an independent impact of female gender on weight gain was observed, although increased fat mass was related only to energy intake. Increased total lean mass was related to low steroid doses and the absence of acute rejection and delayed graft function. Bone loss was related to male gender and high steroid doses. CONCLUSION: Changes in body composition during the first year after kidney transplantation are modulated by gender, energy intake, steroid doses, the occurrence of acute rejection, and delayed graft function.

Nutrition in hemodialysis patients previously on a supplemented very low protein diet.

BACKGROUND: Nutritional safety of protein-restricted diets in patients with chronic renal failure is controversial. In the present study, we have assessed the evolution of nutritional status after initiation of hemodialysis in patients previously treated by a supplemented very low protein diet (SVLPD). METHODS: Nutritional data were prospectively collected during the first year of hemodialysis from 15 consecutive patients treated with a SVLPD (0.3 g protein/kg/day supplemented with essential amino acids, calcium, iron, and vitamins) and compared to 15 age- and gender-matched end-stage renal disease (ESRD) patients previously on a less-restricted diet (0.90 +/- 0.21 g protein/kg/day) who started hemodialysis during the same period. Dual-energy x-ray absorptiometry (DEXA) was used to assess body composition at 0, 6, and 12 months. Hemodialysis prescriptions, biologic data and 3-day food records were collected every 3 months. RESULTS: Protein intake was higher than 1.2 g/kg/day in both groups as soon as 3 months after the start of hemodialysis. Albumin and prealbumin increased significantly during the first 6 months in all patients. Body mass index (BMI) increased in all patients (+0.97 +/- 1.31 kg/m2; P < 0.001) reflecting a gain in fat mass in the overall population (+2.36 +/- 2.94 kg/m2; P < 0.001) while lean body mass remained stable overall. CONCLUSION: Once on hemodialysis, SVLPD patients rapidly increased protein intake. Nutritional status improved in all patients, with a gain in fat mass in all, and a gain in lean body mass in SVLPD men only. These data indicate that treatment with a SVLPD prior to hemodialysis initiation is nutritionally safe.

[Voluntary poisoning by ingestion of Datura stramonium. Another cause of hospitalization in youth seeking strong sensations]. / L'intoxication volontaire par ingestion de Datura stramonium. Une autre cause d'hospitalisation des jeunes en quête de sensations fortes.

Natural hallucinogenic substances have been used in numerous cultures throughout the world for millenniums, providing a sacred intermediary between men and gods. They were used during initiatory, divinatory rites and played an essential role in the myths of exorcism and charm where the initiated enters a sort of trance which separates the soul from the body before "revival". It resulted that a number of plants were given names reflecting their relationship with the divinities, bestowing upon them an aura of mystery and sacredness. With the development of free information superhighways via the net, recipes using these hallucinogenic substances can now travel anywhere on the planet, offering the non-initiated a means of experimenting their search for strong sensations. At the same time, the science of botany has undergone a major revolution. Patient observation of nature is no longer necessary since a well-conducted computer search can easily yield a large supply of plants offered for on-line purchase. Children and adolescents in primary and secondary schools are becoming a new target for the botanical market: young people exchange the latest recipes and Internet addresses, or more simply the objects of their new on-line purchase. This has led to an outbreak in the use of mushrooms and hallucinogenic plants where the cultural notion of initiation or sacred rites has metamorphosed into a phenomenon of communication between young people, notably during festive parties. Datura stramonium has become quite popular and the number of hospitalizations for acute datura poisoning has increased rapidly, as indicated by the statistics of the Bordeaux Poison Center (14 hospitalizations for voluntary poisonings with datura in 2002, compared with 5 in 2001). Besides the self-inflicted risk, one of the most important problems is the delay to diagnosis, simply because the primary care physician did not think of such an "exotic" cause. We report here the case of a 22-year-old young man hospitalized following ingestion Datura stramonium seeds. He presented confusions and dreamlike frenzy. The clinical course was favorable in 72 hours with symptomatic treatment, marked by amnesia of the episode.