Schaap G H, Bilo H J, van der Meulen J, Oe P L, Donker A J
Department of Internal Medicine, Hospital Oudenrijn Utrecht, The Netherlands.
Nephron. 1993;64(2):207-15. doi: 10.1159/000187316.
Protein restriction is advocated in patients with chronic renal insufficiency (CRI) in an attempt to slow down further renal function deterioration, with the most obvious effect in patients with chronic glomerulonephritis (GN) and diabetic nephropathy, and much less in other disease entities, such as adult polycystic kidney disease (APKD), tubulointerstitial nephritis (TIN) and nephrosclerosis (NS). The mechanism by which protein restriction slows down the progression of renal failure remains unclear. Decline of hyperfiltration has been implicated. Whether long-term protein restriction in patients with CRI is associated with a decrease in hyperfiltration is not clear. We studied the effects of prolonged protein intake variation (isocaloric diets in 4-week periods of low (goal: 30-40 g protein daily) and high protein intake (goal: 80-90 g daily) on renal function in 51 patients with CRI. Patients were divided into subgroups according to the underlying renal disease (GN, n = 17; APKD, n = 9; TIN, n = 12; NS, n = 13). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured at the end of each study period. Overall, GFR rose from 39 (9-90) to 46 (9-100) ml/min/1.73 m2 (median and ranges, p < 0.01), and ERPF from 158 (39-558) to 171 (32-676) ml/min/1.73 m2 (p < 0.01). GFR rose significantly in GN (15%, range -23 to 51%), APKD (5%, range -10 to 33%), and NS (8%, range -8 to 25%). ERPF only rose significantly in GN (14%, range -45 to 47%) and APKD (9%, range -9 to 25%).(ABSTRACT TRUNCATED AT 250 WORDS)
对于慢性肾功能不全（CRI）患者，提倡进行蛋白质限制，以试图减缓肾功能的进一步恶化，这在慢性肾小球肾炎（GN）和糖尿病肾病患者中效果最为明显，而在其他疾病实体中效果则要小得多，如成人多囊肾病（APKD）、肾小管间质性肾炎（TIN）和肾硬化（NS）。蛋白质限制减缓肾衰竭进展的机制尚不清楚。超滤的下降被认为与之有关。CRI患者长期蛋白质限制是否与超滤减少有关尚不清楚。我们研究了51例CRI患者在4周期间摄入不同量蛋白质（低蛋白摄入期目标为每日30 - 40克，高蛋白摄入期目标为每日80 - 90克，热量相同）对肾功能的影响。患者根据潜在的肾脏疾病分为亚组（GN，n = 17；APKD，n = 9；TIN，n = 12；NS，n = 13）。在每个研究期结束时测量肾小球滤过率（GFR）和有效肾血浆流量（ERPF）。总体而言，GFR从39（9 - 90）升至46（9 - 100）ml/min/1.73 m²（中位数及范围，p < 0.01），ERPF从158（39 - 558）升至171（32 - 676）ml/min/1.73 m²（p < 0.01）。GFR在GN（15%，范围 - 23%至51%）、APKD（5%，范围 - 10%至33%）和NS（8%，范围 - 8%至25%）中显著升高。ERPF仅在GN（14%，范围 - 45%至47%）和APKD（9%，范围 - 9%至25%）中显著升高。（摘要截断于250字）
