妊娠、蛋白尿、植物性补充饮食与局灶节段性肾小球硬化:三例报告及文献评价。

Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature.

机构信息

Materno-Foetal Unit, Department of Surgery, University of Torino, 10100 Turin, Italy.

SCDU Nephrology, Città della Salute e della Scienza, University of Torino, 10100 Turin, Italy.

出版信息

Nutrients. 2017 Jul 19;9(7):770. doi: 10.3390/nu9070770.

Abstract

Chronic kidney disease (CKD) is increasingly recognized in pregnant patients. Three characteristics are associated with a risk of preterm delivery or small for gestational age babies; kidney function reduction, hypertension, and proteinuria. In pregnancy, the anti-proteinuric agents (ACE-angiotensin converting enzyme-inhibitors or ARBS -angiotensin receptor blockers) have to be discontinued for their potential teratogenicity, and there is no validated approach to control proteinuria. Furthermore, proteinuria usually increases as an effect of therapeutic changes and pregnancy-induced hyperfiltration. Based on a favourable effect of low-protein diets on proteinuria and advanced CKD, our group developed a moderately protein-restricted vegan-vegetarian diet tsupplemented with ketoacids and aminoacids for pregnant patients. This report describes the results obtained in three pregnant patients with normal renal function, nephrotic or sub-nephrotic proteinuria, and biopsy proven diagnosis of focal segmental glomerulosclerosis, a renal lesion in which hyperfiltration is considered of pivotal importance (case 1: GFR (glomerular filtration rate): 103 mL/min; proteinuria 2.1 g/day; albumin 3.2 g/dL; case 2: GFR 86 mL/min, proteinuria 3.03 g/day, albumin 3.4 g/dL; case 3: GFR 142 mL/min, proteinuria 6.3 g/day, albumin 3.23 g/dL). The moderately restricted diet allowed a stabilisation of proteinuria in two cases and a decrease in one. No significant changes in serum creatinine and serum albumin were observed. The three babies were born at term (38 weeks + 3 days, female, weight 3180 g-62th centile; 38 weeks + 2 days, female, weight 3300 g-75th centile; male, 38 weeks + 1 day; 2770 g-8th centile), thus reassuring us of the safety of the diet. In summary, based on these three cases studies and a review of the literature, we suggest that a moderately protein-restricted, supplemented, plant-based diet might contribute to controlling proteinuria in pregnant CKD women with focal segmental glomerulosclerosis. However further studies are warranted to confirm the potential value of such a treatment strategy.

摘要

慢性肾脏病(CKD)在孕妇中越来越受到关注。肾功能减退、高血压和蛋白尿是与早产或胎儿生长受限相关的三个特征。在怀孕期间,由于潜在的致畸性,抗蛋白尿药物(ACE-血管紧张素转换酶抑制剂或 ARBS-血管紧张素受体阻滞剂)必须停药,并且没有经过验证的方法来控制蛋白尿。此外,由于治疗变化和妊娠诱导的超滤,蛋白尿通常会增加。基于低蛋白饮食对蛋白尿和晚期 CKD 的有益影响,我们小组为孕妇开发了一种适度限制蛋白质的纯素-素食饮食,该饮食补充了 ketoacids 和氨基酸。本报告描述了三位肾功能正常、肾病或亚肾病蛋白尿、活检证实局灶节段性肾小球硬化(一种认为超滤是关键的肾病变)的孕妇患者的结果。病例 1:GFR(肾小球滤过率):103 mL/min;蛋白尿 2.1 g/天;白蛋白 3.2 g/dL;病例 2:GFR 86 mL/min,蛋白尿 3.03 g/天,白蛋白 3.4 g/dL;病例 3:GFR 142 mL/min,蛋白尿 6.3 g/天,白蛋白 3.23 g/dL。适度限制饮食可使两种情况下的蛋白尿稳定,一种情况下的蛋白尿减少。血清肌酐和血清白蛋白没有明显变化。三个婴儿均足月出生(38 周+3 天,女,体重 3180 g-第 62 百分位;38 周+2 天,女,体重 3300 g-第 75 百分位;男,38 周+1 天,体重 2770 g-第 8 百分位),这使我们对饮食的安全性感到放心。总之,基于这三个病例研究和文献回顾,我们建议适度限制蛋白质、补充植物性饮食可能有助于控制局灶节段性肾小球硬化的 CKD 孕妇的蛋白尿。但是,需要进一步的研究来证实这种治疗策略的潜在价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5943/5537884/b6f924cf7bce/nutrients-09-00770-g001.jpg

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