PROTEIN RESTRICTION RETARDS PROGRESSION OF RENAL FAILURE

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PROTEIN RESTRICTION RETARDS PROGRESSION OF RENAL FAILURE.

In even mild, chronic renal insufficiency a large fraction of nephrons have been destroyed. Addis, and more recently Brenner, have postulated that in patients with chronic renal insufficiency, residual viable nephrons are forced to compensate, which overworks them and leads to their progressive destruction. Reducing the work of residual nephrons should thus retard the progression of renal failure. Dietary protein restriction and blood pressure control are ways of reducing the nephrons' workload.

This prospective, randomized, 18-month study of 64 patients supports Addis' and Brenner's hypothesis. Half of the patients were randomized to a low-protein diet; all had good blood pressure control. By the end of the study, 6 percent of patients on the low-protein diet developed end- stage renal disease as compared with 27 percent of the patients on a regular diet. The glomerular filtration rate was preserved in the protein-restricted patients. However, the low-protein diet was difficult for patients to tolerate, and a few parameters suggested that the diet caused some nutritional deficiency (the clinical significance of which is unclear). Large-scale studies are under way to further test the "overworked nephron" hypothesis.

— ALK

Published in Journal Watch General Medicine January 2, 1990

Citation(s):

Ihle BU et al. The effect of protein restriction on the progression of renal insufficiency. N Engl J Med 1989 Dec 28 321 1773-1777.

Medline abstract (Free)

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