The role of urea-induced osmotic diuresis and hypernatremia in a critically ill patient: case report and literature review / O papel da diurese osmótica induzida por ureia na geração de hipernatremia no paciente crítico: relato de caso e revisão da literatura

Abstract Hypernatremia is a common electrolyte problem at the intensive care setting, with a prevalence that can reach up to 25%. It is associated with a longer hospital stay and is an independent risk factor for mortality. We report a case of hypernatremia of multifactorial origin in the intensive care setting, emphasizing the role of osmotic diuresis due to excessive urea generation, an underdiagnosed and a not well-known cause of hypernatremia. This scenario may occur in patients using high doses of corticosteroids, with gastrointestinal bleeding, under diets and hyperprotein supplements, and with hypercatabolism, especially during the recovery phase of renal injury. Through the present teaching case, we discuss a clinical approach to the diagnosis of urea-induced osmotic diuresis and hypernatremia, highlighting the utility of the electrolyte-free water clearance concept in understanding the development of hypernatremia.

Resumo A hipernatremia é um distúrbio eletrolítico comum no ambiente de terapia intensiva, com uma prevalência que pode chegar a 25%. Está associada a maior tempo de internação hospitalar e é um fator de risco independente para a mortalidade. Este relato ilustra um caso de hipernatremia de origem multifatorial no ambiente de terapia intensiva. Destacaremos o papel da diurese osmótica por geração excessiva de ureia, uma causa de hipernatremia pouco conhecida e subdiagnosticada. Este cenário pode estar presente em pacientes em uso de elevadas doses de corticoides, com sangramento gastrointestinal, em uso de dietas e suplementos hiperproteicos e estado de hipercatabolismo, especialmente durante a fase de recuperação de injúria renal. A seguir, discutiremos uma abordagem clínica para o diagnóstico da hipernatremia secundária à diurese osmótica induzida por ureia, destacando a importância do conceito de clearance de água livre de eletrólitos nesse contexto.

Effect of phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention

ABSTRACT Phyllanthus niruri (P.niruri) or stone breaker is a plant commonly used to reduce stone risk, however, clinical studies on this issue are lacking. Objective: To prospectively evaluate the effect of P. niruri on the urinary metabolic parameters of patients with urinary lithiasis. Materials and Methods: We studied 56 patients with kidney stones <10mm. Clinical, metabolic, and ultrasonography assessment was conducted before (baseline) the use of P. niruri infusion for 12-weeks (P. niruri) and after a 12-week (wash out) Statistical analysis included ANOVA for repeated measures and Tukey's/McNemar's test for categorical variables. Significance was set at 5%. Results: Mean age was 44±9.2 and BMI was 27.2±4.4kg/m2. Thirty-six patients (64%) were women. There were no significant changes in all periods for anthropometric and several serum measurements, including total blood count, creatinine, uric acid, sodium, potassium, calcium, urine volume and pH; a significant increase in urinary potassium from 50.5±20.4 to 56.2±21.8 mg/24-hour (p=0.017); magnesium/creatinine ratio 58±22.5 to 69.1±28.6mg/gCr24-hour (p=0.013) and potassium/creatinine ratio 39.3±15.1 to 51.3±34.7mg/gCr24-hour (p=0.008) from baseline to wash out. The kidney stones decreased from 3.2±2 to 2.0±2per patient (p<0.001). In hyperoxaluria patients, urinary oxalate reduced from 59.0±11.7 to 28.8±16.0mg/24-hour (p=0.0002), and in hyperuricosuria there was a decrease in urinary uric acid from 0.77±0.22 to 0.54±0.07mg/24-hour (p=0.0057). Conclusions: P.niruri intake is safe and does not cause significant adverse effects on serum metabolic parameters. It increases urinary excretion of magnesium and potassium caused a significant decrease in urinary oxalate and uric acid in patients with hyperoxaluria and hyperuricosuria. The consumption of P.niruri contributed to the elimination of urinary calculi.

Renal biomarkers of male and female Wistar rats (Rattus norvegicus) undergoing renal ischemia and reperfusion

PURPOSE: To investigate biomarkers of acute renal injury in Wistar rats, subjected to left renal ischemia for 10 minutes, and then compare reperfusion at 24 hours, and at 5, 7, 14 and 21 days after the procedure. METHODS: Eight female and male rats between 60 and 81 days old were used in the Central Animal Facility of the UFMS. Assessed biomarkers included urine protein, urea, creatinine, glucose, sodium, potassium, urine alkaline phosphatase and gamma-glutamyl transferase activities, and protein-to-creatinine ratio; and in serum: urea, creatinine, sodium and potassium, fractional excretion of sodium, potassium, urine flow and creatinine clearance. RESULTS: Greater variance was observed in the parameters at 24 hours and at five days (p<0.05) after reperfusion. On the 21st day, these parameters approximated those obtained for the control group. CONCLUSIONS: Renal ischemia for 10 minutes was sufficient to raise urine levels of protein, glucose, fractional excretion of potassium, urea, creatinine clearance, urine activity of gamma-glutamyltransferase and alkaline phosphatase enzymes in the first 24 hours, up to five days after reperfusion, which may indicate risk of acute kidney injury, according to the RIFLE classification. .

Benefits of a Continuous Ambulatory Peritoneal Dialysis (CAPD) Technique with One Icodextrin-Containing and Two Biocompatible Glucose-Containing Dialysates for Preservation of Residual Renal Function and Biocompatibility in Incident CAPD Patients

In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Delta1.2+/-2.9 mL/min/1.73 m2, P=0.027) and urine volume (-Delta363.6+/-543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Delta0.5+/-2.7 mL/min/1.73 m2, P=0.266; -Delta108.6+/-543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, beta2-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549]

Benefits of a Continuous Ambulatory Peritoneal Dialysis (CAPD) Technique with One Icodextrin-Containing and Two Biocompatible Glucose-Containing Dialysates for Preservation of Residual Renal Function and Biocompatibility in Incident CAPD Patients

In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Delta1.2+/-2.9 mL/min/1.73 m2, P=0.027) and urine volume (-Delta363.6+/-543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Delta0.5+/-2.7 mL/min/1.73 m2, P=0.266; -Delta108.6+/-543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, beta2-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549]

Blood Urea & Salivary Urea levels in End Stage Renal Failure.

Elevation of Blood Urea Nitrogen in renal diseases results concomitant increase in Salivary Urea levels. Aims : Determine if there was any correlation between the Salivary Urea levels with that of Blood Urea levels. Material & Methods : samples of blood and saliva were taken from Hemodialysis and control groups to assess the Blood Urea Nitrogen (BUN) and Salivary Urea (SU) levels respectively under strict aseptic precautions. Informed consent was taken from patients and ethical committee approval taken. Results : showed no statistically significant difference between Blood Urea and Salivary Urea in the Hemodialysis group (p>0.05). There was a statistically significant difference between Hemodialysis group and Control group with respect to Blood Urea and Salivary Urea levels. (p<0.001). Conclusion : saliva can be used as a noninvasive diagnostic marker tool.

Biochemical study of the effects of cilostazol in rats subjected to acute ischemia and reperfusion of hind limbs

PURPOSE: To investigate whether cilostazol has a protective effect on acute ischemia and reperfusion of hind limbs of rats through study of biochemical variables in blood and urine. METHODS: Forty six animals were randomized and divided into two groups. Group I received a solution of cilostazol (10 mg/Kg) and group II received saline solution 0.9% (SS) by orogastric tube after ligature of the abdominal aorta. After four hours of ischemia the animals were divided into four subgroups: group IA (Cilostazol): two hours of reperfusion. Group IIA (SS): two hours of reperfusion. Group IB (Cilostazol): six hours of reperfusion. Group IIB (SS) six hours of reperfusion. After the reperfusion period, was held to collect urine and blood for biochemical measurements. The biochemical parameters studied were: urea, creatinine, sodium, potassium and myoglobin in blood and urea, creatinine, myoglobin in urine. RESULTS: There was no statistically significant difference between groups. CONCLUSION: Cilostazol had no protective effect on ischemic acute reperfusion of hind limbs of rats in this model.

Aqueous extract of Allium sativum L bulbs offer nephroprotection by attenuating vascular endothelial growth factor and extracellular signal-regulated kinase-1 expression in diabetic rats.

To investigate the nephroprotective effect of garlic and elucidate the mechanism by which it prevents the progression of diabetic nephropathy in diabetic rats, diabetes was induced by a single ip injection of streptozotocin (45 mg/kg body weight). Garlic extract (500 mg/kg body weight) and aminoguanidine (1 g/L) were supplemented in the treatment groups. Histopathological examination using H&E, PAS staining and the immunohistochemical analysis of vascular endothelial growth factor (VEGF) and extracellular signal-regulated kinase-1 (ERK-1) expression were performed on kidney sections at the end of 12 weeks. Significant change in both, the urine and serum biochemistry confirmed kidney damage in diabetic animals which was further confirmed by the histological changes such as mesangial expansion, glomerular basement membrane thickening, glycosuria and proteinuria. However, the diabetic animals treated with garlic extract showed a significant change in urine and serum biochemical parameters such as albumin, urea nitrogen and creatinine compared to that of diabetic rats. Further, the garlic supplemented diabetic rats showed a significant decrease in the expression of VEGF and ERK-1 compared to diabetic rats, attenuating mesangial expansion and glomerulosclerosis. Thus, garlic extract rendered nephroprotection in diabetic rats.

Efeito da suplementação de L-arginina sobre a secreção de hormônio do crescimento e fator de crescimento semelhante à insulina em adultos / Effect of L-arginine supplementation on secretion of human growth hormone and insuline-like growth factor in adults

Baseado nos pressupostos de que a infusão de aminoácidos pode aumentar a secreção de hormônio de crescimento (GH), e que o metabolismo deste hormônio está relacionado com a secreção do fator de crescimento semelhante à insulina (IGF-I), o objetivo deste estudo foi verificar o efeito da suplementação de L-arginina sobre o GH e IGF-I em adultos. Participaram do estudo 17 indivíduos do sexo masculino, que foram randomizados para receber L-arginina (n= 10) ou placebo (n= 7), sete gramas ao dia, durante um período de sete dias. Antes e após o período de suplementação, os voluntários realizaram coleta de sangue em jejum para verificação dos níveis séricos de GH e IGF-I, bem como coleta de urina para verificação da excreção de uréia. Ao final do período experimental, verificamos que o grupo que recebeu L-arginina aumentou a excreção de uréia na urina (de 2684,1 ± 475,2 mg/dl para 2967,2 ± 409,7 mg/dl, p= 0,002), entretanto não modificou significativamente a secreção dos hormônios avaliados. O grupo que recebeu placebo não alterou significativamente nenhum parâmetro avaliado. A suplementação de L-arginina durante sete dias mostrou-se ineficaz para aumentar a secreção de GH e IGF-I em indivíduos adultos do sexo masculino.

Based on presumptions that the infusion of amino acids can augment the release of human growth hormone (hGH) and that this metabolism is related with secretion of insulin-like growth factor I (IGF-I), the purpose of this study was to verify the effect of L-arginine supplementation on GH and IGF-I in adults. Seventeen male individuals participated on the study and were randomized to receive L-arginine (n= 10) or placebo (n= 7), seven grams per day for seven days. Before and after the supplementation period, the volunteers realized blood collection in fasting to verify both GH and IGF-I levels, as well as urine collection to verify urea excretion. At the end of the experimental period, it was verified that the group that received L-arginine augmented the urea in urine excretion (to 2684.1 ± 475.2 mg/dl from 2967.2 ± 409.7 mg/dl, p= 0.002), therefore it did not alter significantly the release of hormones evaluated. The group which received placebo did not alter significantly any evaluated parameters. The L-arginine supplementation during seven days was ineffective to augment both GH and IGF-I release in individual male adults.

The role of serum and urinary urea in the evaluation of enteral protein intake in adequate and small-for-gestational-age very low birth weight infants

INTRODUÇÃO E OBJETIVOS: Os recém-nascidos de muito baixo-peso (RNMBP) têm necessidades nutricionais especiais. Existe uma tendência atual de se individualizar a oferta protéica para essas crianças. O objetivo do trabalho é determinar a utilidade da uréia sérica e urinária como indicadores da oferta protéica em RNMBP adequados (AIG) e pequenos para a idade gestacional (PIG). TIPO DE ESTUDO E LOCAL: Estudo prospectivo realizado no Berçário Anexo à Maternidade Instituto da Criança "Prof. Pedro de Alcântara" do Hospital das Clínicas, Departamento de Pediatria da Faculdade de Medicina, Universidade de São Paulo, Brasil. MÉTODOS: Setenta e dois RNMBP (oferta protéica média = 3,7 g/kg/dia) foram incluídos, em um estudo de coorte prospectivo, em dois grupos: AIG (n = 34) e PIG (n = 38). Amostras de sangue, coletas de urina de seis horas (Ur6h) e em amostras isoladas (AIUr) foram obtidas para determinação de uréia e creatinina após a 3ª semana de vida e duas semanas após. Análise estatística: teste t de Student, correlação de Pearson e regressão linear (p < 0,05). RESULTADOS: Não houve diferença entre os grupos quanto aos níveis de uréia sérica, uréia Ur6h e uréia AIUr, bem como entre as duas avaliações dentro de cada grupo. A uréia sérica correlacionou-se à uréia Ur6h nos RNAIG e nos PIG, bem como à uréia AIUr nos RNPIG. A uréia Ur6h correlacionou-se à uréia AIUr nos RNAIG e nos RNPIG. Não houve correlação entre a oferta protéica e a uréia sérica ou urinária. CONCLUSÕES: A uréia sérica e a urinária não refletiram a oferta protéica quando foram utilizadas ofertas médias de 3,7 g/kg/dia. Uréia AIUr pode ser tão confiável quanto uréia da urina coletada por períodos mais longos.

Efeito do tempo total de circulaçäo extracorpórea em cirurgia de revasculaçäo miocárdica sobre a perda urinária de nitrogênio na forma de uréia / Effect of total extracorporeal circulation time in myocardial revascularization surgery on urinary urea nitrogen loss

A circulação extracorpórea em cirurgia cardíaca pode ser comparada a um trauma cirúrgica mais intenso. Para verificar a influência do uso de circulação extracorpórea sobre o catabolismo protéico, foram avaliados, prospectivamente, 105 pacientes submetidos a revascularização miocárdica. Tais pacientes foram avaliados de acordo com sexo, idade, tempo de circulação extracorpórea e número de enxertos realizados. No período pós-operatório imediato, o nitrogênio urinário na forma de uréia foi analisado por meio de método enzimático. Análise estatística (análise de correlação e regressão linear múltipla) foi efetuada. Sexo, idade e tempo de circulação extracorpórea não se correlacionaram com a perda urinária de nitrogênio, mas houve correlação positiva com o maior número de enxertos na revascularização. Em conclusão, a circulação extracorpórea não influenciou a perda urinária de nitrogênio, mas houve correlação positiva com o maior número de enxertos na revascularízação. Em conclusão, a circulação extracorpórea não influenciou a perda urinária de nitrogênio. O número de enxertos mais elevado proporcionou maior perda nitrogenada.

Simultaneous analysis of urinary 2-thiothiazolidine-4-carboxylic acid and thiocarbamide as a biological exposure index for carbon disulfide exposure

The objectives of this study were to develop optimal analytic methods for detecting urinary 2-thiothiazolidine-4-carboxylic acid (TTCA) and thiocarbamide simultaneously and to evaluate the usefulness of these metabolites to a biological exposure index (BEI) for carbon disulfide (CS2) exposure. For this experiment, synthesized TTCA and thiocarbamide were used. The synthesized TTCA was identified by infrared spectrophotometer, nuclear magnetic resonance spectrometer and thin layer chromatography. The recovery rates of both metabolites were calculated to find the optimum analytical method. The amounts of urinary TTCA and thiocarbamide were measured by using an ultraviolet detector connected to high performance liquid chromatography (HPLC) after the administration of CS2 (350, 700 mg/kg) into Sprague-Dawley rats intraperitoneally. The maximum absorbance wave lengths for TTCA and thiocarbamide were 272 and 236 nm, respectively. Ethyl acetate extraction with NaCl as a salting-out reagent was used as a simultaneous extraction method for these metabolites. HPLC conditions for these metabolites included using a NH2 column, 50 mM KH2PO4: acetonitrile (85:15) and pH 3. Excreted amounts of urinary TTCA and thiocarbamide were increased significantly following CS2 administration. TTCA, which was already adopted as a BEI for CS2 by the American Conference of Governmental Industrial Hygienists (ACGIH), seems to be a more useful BEI for CS2 exposure than thiocarbamide. However further studies are needed to increase analytical efficiency before thiocarbamide can be adopted as a BEI and to apply this analytic method for simultaneous analysis of these metabolites in workers exposed to CS2.

Metabolic assessment and enteral tube feeding usage in children with acute neurological diseases

Objective: To report on acquired experience of metabolic support for children with acute neurological diseases, emphasizing enteral tube feeding usage and metabolic assessment, and also to recommend policies aimed towards improving its implementation. Design: Retrospective analysis. Setting: Pediatric Intensive Care Unit of Hospital do Servidor Publico Estadual de Sao Paulo. Subjects: 44 patients consecutively admitted to the Pediatric ICU over a period of 3 years who were given nutrition and metabolic support for at least 72 hours. Head trauma, CNS infections and craniotomy post-operative period following tumor exeresis were the main diagnoses. Measurements: Records of protein-energy intake, nutrient supply route, nitrogen balance and length of therapy. Results: From a total of 527 days of therapy, single parenteral nutrition was utilized for 34.3 per cent and single enteral tube feeding for 79.1 per cent of that period 61.4 per cent of the children were fed exclusively via enteral tube feeding, 9.1 per cent via parenteral and 39.5 per cent by both routes. The enteral tube feeding was introduced upon admission and transpyloric placement was successful in 90 per cent of the cases. Feeding was started 48 hours after ICU admission. The caloric goal was achieved on the 7th day after admission, and thereafter parenteral nutrition was interrupted. The maximum energy supply was 104.2 + 23.15 kcal/kg. The median length of therapy was 11 days (range 4-38). None of the patients on tube feeding developed GI tract bleeding, pneumonia or bronchoaspiration episodes and, of the 4 patients who were given exclusive TPN, 2 developed peptic ulcer. The initial urinary urea nitrogen was 7.11 g/m2 and at discharge 6.44 g/m2. The protein supply increased from 1.49 g/kg to 3.65 g/kg (p<0.01). The nitrogen balance increased from - 7.05 to 2.2 g (p<0.01). Conclusions: Children with acute neurological diseases are hypercatabolic and have high urinary nitrogen losses. The initial negative nitrogen balance can be increased by more aggressive feeding regimes than the usual ones. Early tube feeding was well tolerated, which permits the conclusion that it is a safe and effective method for nutrition support. Recommendations of basic rules for metabolic support are made.

Comportamiento endocrino-metabólico de las fracturas de tercio medio facial / Endocrine and metabolic behavior of the fractures of the medial facial third

Se valoran los resultados del comportamiento endocrino-metabólico en 40 pacientes con fracturas del tercio medio facial: 10 nasales, 20 maxilomalares, 2 Lefort I, 4 Lefort II y 4 Lefort III. Según el sexo, 34 pacientes correspondieron al sexo masculino y 6 al femenino. Cuantificamos en orina (muestras de 24 horas): cloruro, sodio, potasio, urea y creatinina; en el ionograma en sangre: cloro, sodio, y potasio; en la química sanguínea: glucosa, clacio, fósforo, urea y creatinina y hemograma con diferencial. Estas muestras se cuantificaron al llegar el paciente, a las 72 horas y a las 24 horas del posoperatorio inmediato. En todos los pacientes estudiados se mantuvo la estabilidad endocrino-metabólica, con excepción de aquéllos portadores de Lefort I, II y III, los cuales en la última muestra tomada presentaron alteraciones del sodio y potasio en el ionograma de orina y sangre

Influência do grau de comprometimento hepático sobre a circulaçäo e excreçäo renal do ácido úrico, em pacientes cirróticos / Influence of the degreees of chronic hepatic failure on the circulation and renal excretion of uric acid in cirrhotic patients

A influência do grau de insuficiência hepatocelular (na cirrose hepática) sobre a circulaçäo e excreçäo do ácido úrico foi investigada em 12 pacientes cirróticos, de etiologia alcoólica, classificados em Child A (n=5) e Child B+C (n=7), todos do sexo masculino de 27 a 59 anos de idade, comparativamente ao grupo controle saudável (n=5), pareado por sexo e idade. A excreçäo urinária do ácido úrico e dos demais metabólitos nitrogenados (uréia, amônia e creatinina) foi estudada nas condiçöes de dieta hipoprotéica-hipoenergética (0,4g-20kcal/kg/d) e normoprotéica-normoenergética (1,14g-38kcal/kg/d). Os níveis séricos de ácido úrico, de albumina e alfa-1 antitripsina (alfa 1AT) foram determinados em amostras de sangue obtidas após jejum. A presença da doença hepática resultou na elevaçäo dos níveis de alfa 1AT, e o agravamento hepatocelular, na queda de albuminemia, sem alteraçäo significativa do ácido úrico circulante. A excreçäo urinária do ácido úrico foi semelhante entre os grupos, em ambas as dietas, porém, na dieta hipoprotéica-hipoenergética, o ácido úrico näo acompanhou o padräo de excreçäo da uréia e da creatinina, o que pode ser atribuído às quedas da ureogênese e da massa muscular (creatinogênese), com o agravamento da doença ou a maior capacidade renal em reter ácido úrico, nestas condiçöes. Isto pode ser configurado matematicamente, relacionando-se metabólitos excretados na urina com seus níveis plasmáticos, mostrando hipoexcreçäo de 45 por cento dos hepatopatas, tanto para o ácido úrico como para a creatinina. Assim, a menor produçäo hepática do ácido úrico, pelos pacientes cirróticos, seria compensada pela menor excreçäo renal do metabólito, preservando os níveis plasmáticos. A importância fisiológica deste processo adaptativo estaria fundamentada na participaçäo do estresse oxidativo, na gênese e perpetuaçäo da cirrose pelo álcool, e nas propriedades anti-oxidantes do ácido úrico.

A influência de diferentes dietas na excreçäo urinária de cálcio, sódio, ácido úrico e uréia / Influence of different diets on urinary excretion of calcium, sodium, uric acid and urea

Litíase do trato urinário apresenta nítida associaçäo com hábitos alimentares. Procuramos analisar a influência de diferentes dietas: vegetariana, hiperprotéica e hipercálcica na excreçäo de vários constituintes urinários responsáveis pela formaçäo de cálculos renais em nove indivíduos normais. Observamos que a dieta vegetariana diminuiu, de forma significativa, a excreçäo urinária de cálcio, sódios, ácido úrico, uréia e creatinina. Desta forma, este tipo de dieta pode ser útil no tratamento de pacientes portadores de cálculos renais no sentido de diminuir a recorrência de litíase

Influencia del flujo de dializado en el aclaramiento de ure, creatinina y ácido úrico en diálisis peritoneal / Influence of dialysate flow rate on the clearence of urea, creatinine and uric acid in peritoneal dialysis

Con el objeto de determinar la influencia del flujo de dializado (Qd) en el aclaramiento de úrea, cratinina y ácido úrico, se evaluaron 22 sesiones de diálisis peritoneal, realizadas en igual número de pacientes a quienes se realizaba el procedimiento por primera vez y cuya indicación fue uremia. Se mantuvo constante la temperatura de dializado, la proporción de recambios hipertónicos y ultrafiltración, no se administró drogas intraperitoneales, salvo heparina y se utilizó la técnica manual. Se dividieron en 3 grupos:1.5, 1.9 y 2.5 Lt/h de Qd. No se encontró diferencias significativas en los aclaramientos de solutos, ni en la transferencia de masa, entre los grupos. La relación D/P (concentración de soluto en el dializado entre su concentración en sangre), disminuyó al incrementarse el Qd en forma lineal, para los 3 solutos. No se encontró diferencia significativa en la pérdida peritoneal de proteínas entre los 3 grupos, sin embargo, se observó una tendencia a ser menor al incrementar el Qd

Endogenous nitrogen excretion in alcoholic patients on an enteral diet

1. Obligatory nitrogen losses were evaluated in a group of 9 chronic alcoholic adult males of low socioeconomic status, with an intake of approximately 1 liter/day of a Brazilian beverage (45% ethanol by weight) for at least 5 years. 2. The patients were fed a nitrofen-free diet orally or by tube for 7 days. Since endogenous nitrogen excretion was statistically similar for all subjects, the data wee pooled for overall analysis. 3. a stable rate of urinary nitrogen output of 28.42 ñ 11.93mg N Kg-1 day-1 was reached in about 3 days both after oral and tube feeding. The obligatory fecal losses for days 4 to 7 were 17.20 ñ 8.86 mg NKg-1 day-1. 4. Based on the factorial approach, considering the skin and other minor nitrogen losses to be 10 mg NKg-1 day-1, the total endogenous obligatory nitrogen loss for this group of alcoholic patients was 55.62 ñ 18.57 mg NKg-1 day-1. 5. The present results are discussed on the basis of the controversy about the nitrogen requirement of alcoholic patients. The endogenous nitrogen excretion demonstrated does not suggest the need for increased nitrogen intake, but the protein malnutrition of the patients points to the need for more protein