Source and Composition in Amino Acid of Dietary Proteins in the Primary Prevention and Treatment of CKD.

Nutrition is a cornerstone in the management of chronic kidney disease (CKD). To limit urea generation and accumulation, a global reduction in protein intake is routinely proposed. However, recent evidence has accumulated on the benefits of plant-based diets and plant-derived proteins without a clear understanding of underlying mechanisms. Particularly the roles of some amino acids (AAs) appear to be either deleterious or beneficial on the progression of CKD and its complications. This review outlines recent data on the role of a low protein intake, the plant nature of proteins, and some specific AAs actions on kidney function and metabolic disorders. We will focus on renal hemodynamics, intestinal microbiota, and the production of uremic toxins. Overall, these mechanistic effects are still poorly understood but deserve special attention to understand why low-protein diets provide clinical benefits and to find potential new therapeutic targets in CKD.

[Taking care of outreach workers who intervene with marginal youths : Part 2]. / Des rencontres de proximité : le prendre soin de soi des intervenants au coeur de l'intervention solidaire pour joindre les jeunes en marge : Deuxième partie.

Outreach work with youths in a precarious situation raises emotions and questions in workers while confronting them with their own suffering and fragility. In order to help them help as well as counter the risk of vicarious traumatisation, spaces for talking and exchanging with a third party have been created in various intervention settings. The objective is to allow them to elaborate on what their work makes them feel and thus preserve their stability and their ability to think. Through group or individual clinical discussions, these exchanges favor distancing and allow new perspectives on their work. That is why peer support appeared as an essential element for psychologists and therapists who support not only youths but the workers who help them. The setting up of our outreach meetings-a result of our observation, allows keeping the flame alive without risking being burned. In this article, the issue of marginality in professionals working with homeless youths-as well as our own-is raised. It sometimes translates in the absence of a fixed location for a meeting symbolizing traditional stability, sometimes in the necessary flexibility of a framework to reach this population, sometimes in the openness to otherness and more precisely to a difference that disturbs when anxiety that this disaffiliated being raises, could well be our very self! Is it really marginality or a particular positioning aiming at constructive denunciation of stigmatization, unjust exclusion that youths with mental health and addiction problems sustain that place them at risk of homelessness? Neither missionaries, nor saviors are needed, but only hopeful facilitators working alongside people who want to stand up and take their place in society.

[Close team work: sharing knowledge, solidarity and hope]. / Des rencontres de proximité: apprendre de l'autre, pour tisser de la solidarité et de l'espoir. Première partie.

A proximity team was created more than eight years ago by a group of health professionals working with disaffiliated and homeless youth in the most precarious of situations. Proximity meetings have continued since that time, despite many changes within the team, including departures and new arrivals. The proximity team is a partnership project which revolves around common values and principles aimed at improving services for youth who find themselves marginalized or at risk of exclusion. Health professionals from various backgrounds explain why they believe in this approach to proximity work.