Kirch W, von Gicycki C
Wien Klin Wochenschr. 1980 Apr 11;92(8):263-6.
There are many publications on various complications of therapeutic starvation, but only few cases and of renal complications have been described. During starvation two characteristic changes in kidney function occur: a reduction in glomerular filtration rate by about 50% and a decrease in renal uric acid clearance by impairment of tubular uric acid secretion with consequent hyperuricaemia. During fasting ketone bodies compete with uric acid for a common tubular secretion site. The development of some of the renal complications described in the literature so far can be explained bal failure with uric acid nephropathy, renal ischaemia and pre-existing kidney disease have been published. Furthermore reversible salt-losing nephropathies were observed. It is essential in the prophylaxis of renal complications during fasting to ensure that a sufficient fluid intake is maintained and the urinary output is controlled. Before therapeutic starvation is commenced parameters of renal function (urinalysis, blood urea, serum creatine, serum uric acid) must be determined and then monitored at regular intervals. After starvation has commenced the administration of uricosuric agents must be avoided and intravenous pyelography is contraindicated.
关于治疗性饥饿的各种并发症有许多出版物，但仅有少数病例描述了肾脏并发症。在饥饿期间，肾功能会出现两个特征性变化：肾小球滤过率降低约50%，肾小管尿酸分泌受损导致肾尿酸清除率下降，继而出现高尿酸血症。在禁食期间，酮体与尿酸竞争共同的肾小管分泌位点。到目前为止，文献中描述的一些肾脏并发症的发生可以用尿酸肾病、肾缺血和既往存在的肾脏疾病导致的肾功能衰竭来解释。此外，还观察到可逆性失盐性肾病。在禁食期间预防肾脏并发症时，确保维持足够的液体摄入量并控制尿量至关重要。在开始治疗性饥饿之前，必须确定肾功能参数（尿液分析、血尿素、血清肌酐、血清尿酸），然后定期监测。饥饿开始后，必须避免使用促尿酸排泄剂，静脉肾盂造影也属禁忌。
