Dietary protein intake and nutritional status in patients with renal transplant.

BACKGROUND: Uremic patients on regular dialysis treatment (RDT) obtain and maintain with difficulty an adequate nutritional status. Successful kidney transplantation allows remarkable rehabilitation of patients with end-stage renal disease previously on RDT. However, information concerning the role of dietary protein restriction in the treatment of patients with chronic transplant rejection is scarce. PATIENTS AND METHODS: The role of dietary protein restriction in the treatment of patients with chronic transplant rejection was studied over 10 years in 42 patients with a kidney transplant to examine longterm renal and nutritional responses to dietary protein on graft renal function. In these patients, renal function was checked monthly, clinical evaluation and anthropometric measurements studied, nutritional status and all patients' diets were recorded. RESULTS: In 18 of these patients, biochemical signs of renal failure were found. A diet with 35 Kcal/kg and 0.7 - 0.8 grams of protein/Kg was instituted. Renal function studied every six months for 10 years showed improvement or stabilization. The low protein diet was associated with a significant reduction in 24-hour urinary protein excretion, without any change in blood pressure. Protein restriction was not associated with changes in serum protein. CONCLUSIONS: Our long-term study suggests that moderate protein intake may improve the course of chronic rejection and that restriction in protein intake may be a useful strategy in slowing the progression of renal disease in chronic rejection.

Regulation of corticosteroid receptors in patients with anorexia nervosa and Cushing's syndrome.

We have studied 16 patients with anorexia nervosa (11 with a stabilised weight loss and 5 in the weight-losing phase), 11 healthy controls, and 10 patients with Cushing's syndrome, by measuring plasma cortisol (by enzyme-immunoassay), ACTH (by RIA), corticosteroid (Type I-mineralocorticoid and Type II-glucocorticoid) receptors in mononuclear leukocytes (by radio-receptor assay), and lymphocyte subpopulations (by cytofluorimetry). In anorexic patients with a stabilised weight loss and in Cushing's syndrome the mean value of both Type I and Type II corticosteroid receptors in mononuclear leukocytes was significantly lower than in controls. The correlation between Type II receptors and plasma cortisol was inverse in stabilised anorexia nervosa and in Cushing's syndrome, and direct in healthy controls. Anorexic patients in the weight-losing phase showed a significant increase in plasma cortisol levels and a normal number of Type II receptors. From these results we hypothesise that in anorexia nervosa there is a progression from an increase in plasma cortisol in the weight-losing phase, to a concomitant decrease in Type II receptors when the disease is stabilised.

Body fluid overload and bioelectrical impedance analysis in renal patients.

Using a new bivariate vectorial approach to the standard bioimpedance analysis (tetrapolar, 50-kHz frequency), we evaluated the performance of a graphical method for the identification of patients with fluid overload. Two hundred and seventeen adult Caucasian subjects were divided into four classification groups: 86 healthy control subjects, 55 patients with mild-to-terminal chronic renal failure in conservative treatment (15% with apparent edema), 36 patients with idiopathic nephrotic proteinuria (58% with apparent edema), and 40 obese subjects. We found a bioimpedance threshold for apparent edema on the lower pole of the sex-specific 75% tolerance ellipse (bivariate tolerance interval) of the healthy population. This innovative graphical method allows identification, monitoring and therapy planning of patients with fluid overload using direct bioimpedance measurements without any assumption on body composition.

The role of the endocrine factors and obesity in hormone-dependent gynecological neoplasias.

Between September 1990 and February 1992, we studied 70 women of post-menopausal age, of whom 33 were affected by hormone-dependent gynecologic tumors and 37 by other pathologies, measuring estrogens, androgens, SHBG and also measuring excess fat and its distribution. The aim of our research was to ascertain what relation there was between adipose tissue, taking account central or peripheric localization, the levels of sex steroids and the onset of endometrial and breast cancer. In the group of tumor patients, we found a quantity of fat mass greater than in the control group (p < 0.05); there was, beside, in the first group, an inverse proportional correlation between the SHBG levels and BMI, and between SHBG and the fat mass (P < 0.05). We also observed an inverse relation between the levels of testosterone and SHBG (P < 0.05). These findings confirm the role that the adipose tissue and androgens would have on the globulin production, which in turn would reflect on the percentage of potentially active steroids in endometrial and mammary tissues. We also wished to ascertain if the distribution of fatty tissue (prevalently abdominal or prevalently gluteo-femoral) could have different endocrine-metabolic consequences. We found a directly proportional relation between an index of central obesity, the T/L Ratio, and the levels of DHA-S (P < 0.05), but the significance of this relation is not clear, inasmuch as DHA-S is one of the least active of the androgens.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lipid levels in children with psoriasis]. / Studio dei livelli lipidemici in bambini psoriasici.

Elevated blood cholesterol (above the 95 degrees percentile) was found in three of thirty-one children with psoriasis, as in adult subjects with psoriasis. Therefore a steadily evaluation of lipids pattern is suggested for patients with psoriasis, even children, in order to start an appropriate management.