Rosenberg M E, Salahudeen A K, Hostetter T H
Department of Medicine, University of Minnesota, Minneapolis, USA.
Kidney Int Suppl. 1995 Dec;52:S102-6.
We examined the effects of dietary protein restriction in fourteen patients with chronic kidney rejection. The patients were randomly assigned, using a crossover design to two 11-day periods, one on a low-protein diet (0.55 g/kg/day) and the other on a high-protein diet (2 g/kg/day). The low protein diet was associated with a significant improvement in glomerular permselectivity without any change in blood pressure, glomerular filtration rate, or renal plasma flow. The low protein diet was also associated with a significant reduction in plasma renin activity. Acute converting enzyme inhibition decreased proteinuria when administered at the end of the high protein diet, but had no additional antiproteinuric effect when given at the end of the low protein diet. Comparable reductions in blood pressure with hydralazine had no effect on proteinuria. Protein restriction was also associated with modest but significant fall in serum proteins. In conclusion, dietary protein restriction may improve the course of renal failure in chronic rejection partly by suppressing the renin-angiotensin system. Studies are needed to establish the safe level of dietary protein restriction in these patients and to assess the efficacy of such restriction in slowing the progression of renal failure.
我们研究了饮食蛋白质限制对14例慢性肾移植排斥患者的影响。采用交叉设计，将患者随机分为两个11天的阶段，一个阶段采用低蛋白饮食（0.55克/千克/天），另一个阶段采用高蛋白饮食（2克/千克/天）。低蛋白饮食与肾小球滤过选择性显著改善相关，而血压、肾小球滤过率或肾血浆流量无任何变化。低蛋白饮食还与血浆肾素活性显著降低相关。在高蛋白饮食结束时给予急性转换酶抑制剂可降低蛋白尿，但在低蛋白饮食结束时给予则无额外的抗蛋白尿作用。用肼屈嗪使血压可比地降低对蛋白尿无影响。蛋白质限制还与血清蛋白适度但显著下降相关。总之，饮食蛋白质限制可能部分通过抑制肾素-血管紧张素系统来改善慢性排斥中肾衰竭的病程。需要开展研究以确定这些患者饮食蛋白质限制的安全水平，并评估这种限制在减缓肾衰竭进展方面的疗效。
