[Nutritional management of kidney diseases in children].

The prevalence of various kidney diseases in children remains high in recent decades. Adequate nutrition management can enhance the effectiveness of drug treatment, slow the frequency of relapses andprevent the progression of the disease. The article is devoted to modern approaches to diet therapy in various kidney diseases in children with the defeat of tubular and glomerular appa ratus. For the first time the therapeutic diets for children with various kidney diseases are presented. Particular attention is paid to diet therapy in nephrotic syndrome (steroid-responsive and steroid-refractory). Dietary approaches with modern formulas for enteral nutrition in cases of steroid therapy complications in children with renal insufficiency (in predialysis stage and on dialysis) are described. Differentiated nutritional approaches for patients with different types of crystalluria are separately presented.

Amelioration of systemic lupus erythematosus by Withangulatin A in MRL/lpr mice.

We have previously reported the anti-inflammatory potential and the possible underlying mechanisms of Withangulatin A (WA), which is an active component isolated from Physalis angulata L. Here, we demonstrated that WA might improve the life quality, as well as reduced the accumulation of proteinuria symptoms and levels of anti-double-stranded DNA antibodies in MRL/lpr mice. Moreover, WA could improve renal histopathologic characteristics of MRL/lpr mice. Intriguingly, expression of B cell-activating factor (BAFF), BAFF-R and related gene in the spleen were significantly reduced in 10 mg/kg WA-treated mice compared with that in 5 mg/kg WA-treated mice and untreated mice. These findings indicate that WA might have a pleiotropic therapeutic effect through their immunosuppression via inhibiting BAFF signaling, which suggest a potential application of this active constituent in the treatment of SLE.

Influence of total western diet on docosahexaenoic acid suppression of silica-triggered lupus flaring in NZBWF1 mice.

Lupus is a debilitating multi-organ autoimmune disease clinically typified by periods of flare and remission. Exposing lupus-prone female NZBWF1 mice to crystalline silica (cSiO2), a known human autoimmune trigger, mimics flaring by inducing interferon-related gene (IRG) expression, inflammation, ectopic lymphoid structure (ELS) development, and autoantibody production in the lung that collectively accelerate glomerulonephritis. cSiO2-triggered flaring in this model can be prevented by supplementing mouse diet with the ω-3 polyunsaturated fatty acid (PUFA) docosahexaenoic acid (DHA). A limitation of previous studies was the use of purified diet that, although optimized for rodent health, does not reflect the high American intake of saturated fatty acid (SFA), ω-6 PUFAs, and total fat. To address this, we employed here a modified Total Western Diet (mTWD) emulating the 50th percentile U.S. macronutrient distribution to discern how DHA supplementation and/or SFA and ω-6 reduction influences cSiO2-triggered lupus flaring in female NZBWF1 mice. Six-week-old mice were fed isocaloric experimental diets for 2 wks, intranasally instilled with cSiO2 or saline vehicle weekly for 4 wks, and tissues assessed for lupus endpoints 11 wks following cSiO2 instillation. In mice fed basal mTWD, cSiO2 induced robust IRG expression, proinflammatory cytokine and chemokine elevation, leukocyte infiltration, ELS neogenesis, and autoantibody production in the lung, as well as early kidney nephritis onset compared to vehicle-treated mice fed mTWD. Consumption of mTWD containing DHA at the caloric equivalent to a human dose of 5 g/day dramatically suppressed induction of all lupus-associated endpoints. While decreasing SFA and ω-6 in mTWD modestly inhibited some disease markers, DHA addition to this diet was required for maximal protection against lupus development. Taken together, DHA supplementation at a translationally relevant dose was highly effective in preventing cSiO2-triggered lupus flaring in NZBWF1 mice, even against the background of a typical Western diet.

Dietary enrichment with the polyunsaturated fatty acid eicosapentaenoic acid prevents proteinuria and prolongs survival in NZB x NZW F1 mice.

Prostaglandins and related compounds are active mediators of inflammation, but data concerning their role in the pathogenesis of the glomerulonephritis of New Zealand Black x New Zealand White (NZB x NZW) F1 mice are conflicting. Dietary eicosapentaenoic acid (EPA, C20:5), a fatty acid analogue of arachidonic acid (C20:4), has been shown to impair platelet aggregation in humans, apparently through inhibition of the synthesis of prostaglandins and thromboxanes from arachidonic acid. We report here the effects of a diet high in EPA on the development of renal disease and survival in female NZB x NZW F1 mice. Animals from 4--5 wk of age were fed diets containing 25% lipid, supplied either as beef tallow or menhaden oil, with fatty acid analysis of less than 0.05 and 14.4% EPA, respectively. In the first experiment, by 13.5 mo of age, mice on the beef tallow diet had all (9/9) developed proteinuria and the majority (6/9) had died, with renal histologic examination revealing severe glomerulonephritis. In contrast, none of 10 menhaden oil-fed animals had developed proteinuria, and all were alive at this time (P less than 0.005 for both proteinuria and survival). In a second experiment using 50 mice in each dietary group, 56% of the beef tallow group vs. none of the menhaden oil group had developed proteinuria at 9 mo of age (P less than 0.005). Native DNA binding at 6 mo of age was 23.9 +/- 14.7 vs. 10.1 +/- 9.7% in the beef and menhaden oil groups, respectively (P less than 0.01). Weights were similar in all groups, and there was no evidence of essential fatty acid deficiency in any group. These results demonstrate that a diet high in EPA protects NZB x NZW F1 mice from the development of glomerulonephritis.

Modulated nitrogen intake for patients on low-protein diets.

In order to overcome malnutrition and poor palatability associated with long lasting low-protein intakes, a diet was devised based on modulated nitrogen intake and energy supply of at least 155 KJ/kg a day. Each patient underwent three different regimens (A, B, C) of protein intake. In period A, the protein intake was 0.33 g/kg a day. In period B, the patients were given 0.33 g/kg a day during day 1, 2, 3, 5, 6 and 1.00 g/kg a day during day 4 and day 7 of the week. In period C the daily protein intake was the mean of the weekly value from day 1 to 7 of period B. Data obtained show that in period A the urea appearance rate was equal to that in period B and lower than that in period C.

Effect of combined treatment of oral sorbent with protein-restricted diet on change of reciprocal creatinine slope in patients with CRF.

BACKGROUND: Low-protein diet (LPD) is one therapy and AST-120, an oral carbon adsorbent, is the other therapy to reduce blood levels of indoxyl sulfate in patients with chronic renal failure (CRF). Based on the different mechanisms of reducing indoxyl sulfate levels, the addition of AST-120 to an LPD was investigated. METHODS: Seven hundred twenty-two patients with chronic glomerulonephritis (CGN) and 162 patients with diabetic nephropathy (DN) were stratified by protein intake: less than 0.50 g/kg/d (0.50-g/kg/d group), 0.51 to 0.65 g/kg/d (0.65-g/kg/d group), and 0.66 to 0.80 g/kg/d (0.80-g/kg/d group). To analyze the effect of combined AST-120 therapy (6 g/d) in patients on LPD therapy, the slope of the reciprocal of serum creatinine (1/Cr slope), which represents progression of CRF, was applied. RESULTS: (1) In patients with CGN, the addition of AST-120 with an LPD was as follows: the 1/Cr slope in the 0.50-g/kg/d (n = 152), 0.65-g/kg/d (n = 318), and 0.80-g/kg/d (n = 252) groups changed significantly from -430 x 10(-5) to -83 x 10(-5), -333 x 10(-5) to -102 x 10(-5), and -431 x 10(-5) to -116 x 10(-5) dL/mg/wk. (2) In patients with DN, the addition of AST-120 with an LPD was as follows: the 1/Cr slope in the 0.65-g/kg/d (n = 74) and 0.80-g/kg/d (n = 68) groups changed significantly from -602 x 10(-5) to -125 x 10(-5) and -646 x 10(-5) to -185 x 10(-5) dL/mg/wk. CONCLUSION: It is suggested that the addition of AST-120 to a mild LPD provides the comparable effect with a strict LPD in the point of suppressing the progress of CRF.

Protein-restricted diets in chronic renal failure: a four year follow-up shows limited indications.

Several retrospective and prospective studies confirmed the beneficial effect of dietary protein restriction (DPR) on the downhill course of renal function in chronic kidney disease. The long-term results of this therapeutic modality may be different than the short-term effects. In our nephrology outpatient department, a prospective randomized trial has been in progress since April, 1982. In 1984, we reported a general beneficial effect of our diet after two years of follow-up. Two hundred and forty-eight patients with initial creatinine clearances between 10 and 60 ml/min entered the trial. Patients were stratified for sex, age and degree of renal insufficiency. One hundred and twenty-nine patients were randomly assigned to a DPR-group (0.4 to 0.6 g/kg/day); 118 patients to a control group. Patients on DPR visited the dietitian every three months during the first 24 months of the study; thereafter, as with the controls, the dietitian visits were only for specific needs. Urea excretion decreased significantly in DPR patients as a sign of good compliance and stayed at that level, even without frequent visits to the dietitian. Biochemical parameters showed no signs of malnutrition. Amino acid profiles were related to the degree of renal failure. The diet appeared to have a selective effect on the progression rate of renal failure: only patients with primary glomerular disease responded to the diet. Furthermore, there were striking intersex differences. Males showed a more rapid decline towards end-stage renal failure, but responded in a positive way to the diet, whereas female patients did not benefit from the dietary manipulation at all.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of proteinuric patients with a vegetarian soy diet and fish oil.

Our aim was to determine whether a longer period of treatment with a vegetarian soy diet with addition of fish oil supplements would accentuate the beneficial effects on hyperlipidemia and proteinuria of nephrotic patients we found in a previous study. After an 8-week baseline period on free diet, patients were randomly allocated either on soy diet alone (SD) or to SD plus 5 g/day of fish oil (SD + FO) orally for two months. Then they crossed over to the other treatment for two additional months. They finally resumed eating the free diet for 3 months. We selected 20 outpatients with chronic glomerulonephritis, proteinuria in the nephrotic range, fasting serum cholesterol > 250 mg/dl, mean serum creatinine concentrations 1.75 +/- 0.23 mg/dl. Serum lipid profile, urinary protein loss and nutritional parameters were monitored. With the soy diet, we obtained a significant decrease both of hyperlipidemia and of proteinuria. The effect of the soy diet on proteinuria increased over the 4 months. The addition of a moderate amount (5 g/day) of fish oil in a randomized cross-over design had no further beneficial effect. Stability of serum albumin, transferrin and the body mass index documented good nutritional status. In conclusion, the dietary manipulation with our vegetarian soy diet confirmed the beneficial effects on hyperlipidemia and proteinuria of nephrotic patients. Such effects persisted and even ameliorated after 4 months of diet. The addition of moderate oral supplements of fish oil did not potentiate the beneficial effect.

Progression rate of residual renal function in conservative treatment and early dialysis.

A retrospective comparative study was carried out in patients with chronic renal failure on conservative treatment (26 cases) and early dialysis (23 cases). The two groups were well matched for age, sex, etiology of renal disease and residual Ccr. In contrast with other papers, patients on dialysis showed a gentler deterioration rate of residual renal function than those on conventional low protein diet regimen. Between the two groups statistically significant differences concerned the control of blood pressure, serum phosphate and uric acid.

[New approaches to the treatment of nephritis]. / Novye podkhody k lecheniiu nefritov.

The paper provides evidence and results of using new therapeutical treatment of glomerulonephritis, such as pulse-therapy with cyclophosphane, therapy with angiotension-converting enzyme (ACE) inhibitors or that with antihyperlipidemic agents. Based on much experience with pulse-therapy with cyclophosphane (over 100 patients with chronic glomerulonephritis (CGN) and lupus nephritis), it is concluded that this method is highly effective. Treating 57 patients with ACE inhibitors has shown that in CGN these drugs should be used only when taking into account their antihypertensive effect and capacity of lowering intraglomerular hypertension, as evidenced by the renal functional reserve, and diminishing proteinuria. The long-term (7-12 month) antihyperlipidemic therapy (diet and lovastatin) in 20 patients with CGN accompanied by the nephrotic syndrome caused a significant reduction in the concentration of serum cholesterol and proteinuria, a significant increase in serum albumin levels; remission of the nephrotic syndrome occurred in 9 patients; but better effects were observed in non-inflammatory nephropathies, such as membranous nephropathy, focal segmental glomerulosclerosis, and nephrosclerosis.

[Means for the inhibition of the nonimmune progression of nephritis]. / Puti tormozheniia neimmunnogo progressirovaniia nefritov.

Inhibition of non-immune progression of renal insufficiency for control of glomerulonephritis was attempted via hemodynamic, metabolic and hypolipidemic means. Hemodynamic correction was conducted using inhibitors of angiotensin-converting enzyme capoten and renitek. The action on metabolic factors of progression was realized by lovastatin mevakor. Capoten and renitek exhibited in 57 patients with chronic nephritis not only a hypotensive effect, but also reduced intraglomerular hypertension and proteinuria. A long-term (7-12 months) hypolipidemic therapy (diet and lovastatin) in 20 patients with chronic glomerulonephritis with nephrotic syndrome resulted in lowering of serum cholesterol concentrations and proteinuria, raised serum albumin. 9 patients achieved remission of nephrotic syndrome. The highest effect occurred in non-inflammatory nephropathy: membranous nephropathy, focal-segmental glomerulosclerosis, nephrosclerosis.

[Changes in lipid metabolic indices in children with chronic kidney diseases under the influence of diet therapy]. / Izmeneniia nekotorykh pokazatelei lipidnogo obmena u detei s khronicheskimi zabolevaniiami pochek pod vliianiem dietoterapii.

Variations in lipid metabolism were studied in 20 children with chronic glomerulonephritis (CGN) associated with the nephrotic syndrome and 14 children with chronic renal insufficiency given protein deficient therapeutic diets. Suggestive abnormalities of lipid metabolism involved hyperlipidemia, hypercholesterinemia and hypertriglyceridemia (more sharply pronounced in patients with CGN associated with the nephrotic syndrome) as well as hyperlipoproteidemia, chiefly of types IY and IIB. Disproportions in lipoproteid spectra of the plasma towards increase in atherogenous beta- and pre-beta-lipoproteids are characteristic for patients of both groups but sharply pronounced in CRI. These patients also show a reduced metabolization efficacy coefficient (MEC) of essential fatty acids of food to the lipid structures of erythrocyte membranes. As a results of the treatment the lipid metabolism returned to normal in most patients with CGN and in part of the patients with CRI. In order to raise the efficacy of therapeutic diets during normalization of lipid metabolism in CRI it is recommended that the fat and carbohydrate components of the diet may be changed qualitatively with due regard for the types of hyperlipoproteidemia.

[Lipid metabolism and free-radical oxidation in children with glomerulonephitis incorporating plant fats into their diet]. / Obmen i svobodnoradikal'noe okislenie lipidov u detei, bol'nykh glomerulonefritom, pri vkliuchenii v dietu rastitel'nykh zhirov.

A study was made of the effect of vegetable fats on lipid metabolism and free radical oxidation, phospholipase activity and antioxidant content in 43 children suffering from chronic glomerulonephritis. After intake of a vegetative fat in a dose of 2 g/kg bw for 7 days the sick children demonstrated a significant rise in the level of total lipids in red cells and in their excretion with urine. This was in a good agreement with an increase in phospholipase activity in blood and diminution of lipid peroxides in red cell membranes. The reaction of antioxidant enzymes metabolizing hydrogen peroxide was different. Catalase activity in urine was elevated, whereas urine peroxidase activity was decreased. All these changes gave rise to a decrease in the pool of peroxide radicals which correlated with the time course of hydroperoxides. The biochemical data indicate that lipids contained by vegetative fats may be regarded as treatment-and-dietetic factor in multiple modality therapy of children with renal diseases.

[The effect of omega-3 polyunsaturated fatty acids on the clinico-biochemical indices and kidney nitrogen-excreting function in patients with chronic kidney failure]. / Izuchenie vliianiia polinenasyshchennykh zhirnykh kislot omega-3 na kliniko-biokhimicheskie pokazateli i azotovydelitel'nuiu funktsiiu pochek u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

The addition of fish oil (20 g for 3 weeks) to diets of 7 patients with chronic renal failure (CRF) contributed to correction of metabolic derangement and nitrogen release, to alleviation of clinical symptoms. The most pronounced positive shifts were reported in early CRF. This gives evidence for a preventive value of diets supplemented with fish oil which secure delay of terminal CRF.

[Diet therapy of patients with chronic diffuse glomerulonephritis]. / Sovremennye aspekty dieticheskoi terapii bol'nykh khronicheskim diffuznym glomerulonefritom

Results of dietotherapy used in dealing with 68 patients suffering from chronic diffuse glomerulonephritis at the stage of chronic renal incompetence and with 50 others with the nephrotic syndrome are reported. The pertinent observations and investigations indicate that the most adequate ration for patients with chronic renal insufficiency is the one containing 40 g of protein. With a far advanced renal incompetence the treatment is to be started with a diet containing 20 g of protein and then, as the condition of the patients gets better, puts them on a diet with 40 g of protein. Observations have also brought out the fact that patients with nephrotic syndrome are in need of a diet containing 1.5-2 g of protein per 1 kg of an edema-free body weight of the patient.

[Phosphorus-calcium metabolism and dietetic correction of its disorders in chronic kidney diseases in children]. / Sostoianie fosforno-kal'tsievogo obmena i dieticheskaia korrektsiia ego narushenii pri khronicheskikh bolezniakh pochek u detei.

Ninety children with varying renal diseases were under observation. The investigations conducted have shown that disorders in phosphoric-calcium metabolism depend on the type, activity of chronic glomerulonephritis (CGN) and etiology of chronic renal insufficiency (CRI). Significant disorders in phosphoric-calcium metabolism were detected in patients with nephrotic and mixed types of CGN. Most manifest clinical and x-ray changes of the osseous system were observed in patients with CRI that developed as a result of the tubulointerstitial pathologic process. Low-phosphate diets with preset amounts of Ca and P were developed, composed of products with relatively low content of P, and of new dietetic products rich in Ca. The diets were used for correction of hyperphosphatemia in children with CGN and in those with CRI, simultaneously with drug therapy, to prevent or diminish disorders in phosphoric-calcium metabolism, and to reduce the risk of invalidism among children with chronic renal diseases.

Keto acid-supplemented low-protein diet for treatment of adult patients with hepatitis B virus infection and chronic glomerulonephritis.

OBJECTIVES: An open-label, randomized, controlled, single-centre clinical trial to evaluate the effects of low-protein intake, with or without keto acid supplementation, on nutritional status and proteinuria, in patients with hepatitis B virus (HBV) and early stage chronic glomerulonephritis. METHODS: Patients with chronic glomerulonephritis and HBV infection were randomized to receive a low-protein diet (0.6-0.8 g/kg ideal body weight [IBW] per day) either without (LP group) or with (sLP group) keto acid supplementation (0.1 g/kg IBW per day), for 12 months. Nutritional, clinical and safety parameters were recorded. RESULTS: The study included 17 patients (LP group n = 9; sLP group n = 8). Proteinuria and microalbuminuria were significantly lower in the sLP group at 6 and 12 months compared with baseline, and at 12 months compared with the LP group. There were no significant differences in serum creatinine level or estimated glomerular filtration rate. Nutritional parameters (serum albumin and prealbumin) were significantly improved at 12 months, compared with baseline, in the sLP group. CONCLUSIONS: Restriction of dietary protein intake to 0.6-0.8 g/kg IBW per day appears to have an acceptable safety profile. Supplementation with keto acids is associated with decreased urine protein excretion.

Short-term effects of soy protein diet in patients with proteinuric glomerulopathies.

INTRODUCTION: It has been suggested that soy protein can slow renal disease progression by decreasing plasma cholesterol and proteinuria in patients with nephropathies. This study was designed to evaluate the effect of soy protein on proteinuria and dyslipidemia, in patients with proteinuric glomerulopathies. PATIENTS AND METHODS: Patients were divided into three groups: Control Group (n = 9) received diet with 0.8 g/kg/day of animal protein; Study Group 1 (n = 9), 0.8 g/kg/day of soy protein; and Group 2 (n = 9), 0.8 g/kg/day of soy protein plus fibers. The study period corresponded to eight weeks. During the baseline period and by the end of the study, patients were submitted to laboratorial and anthropometric evaluation. RESULTS: There was no statistically significant difference between baseline and post-diet periods among the three groups in anthropometric parameters or body composition, neither in proteinuria levels (Control: 0.7 ± 0.6 versus 0.8 ± 0.6; Group 1: 2.0 ± 1.7 versus 1.9 ± 1.8; Group 2: 2.0 ± 1.4 versus 2.1 ± 2.0). However, a slight decrease in triglycerides (244.8 ± 275.9 versus 200.5 ± 34.0), total (234.0 ± 59.4 versus 181.2 ± 110.3) and LDL (136.0 ± 59.1 versus 104.1 ± 39.4) cholesterol in Group 1 was observed, although not significant. CONCLUSION: We have not observed beneficial effects when using soy protein instead of animal protein with the aim of attenuating proteinuria and hyperlipidemia, but we have shown that soy protein has not caused deleterious changes in body composition, ensuring an adequate nutritional state.