RESUMEN
The objectives of this study were to evaluate the effects of food restriction (without protein or phosphorus restriction) and protein restriction (without the restriction of other nutrients or calories) on the outcome of the remnant kidney model of chronic renal failure in rats. After 5/6 nephrectomy, rats were assigned to one of the following dietary groups: group I (control-ad libitum) consumed a 21% casein diet ad libitum; group II (food restriction with protein restriction) consumed 36% less calories, protein and minerals than group I; group III (food restriction without protein restriction) consumed 36% less calories and minerals than group I, but equivalent amounts of protein; group IV (protein restriction) consumed 38% less protein than group I, but equivalent amounts of calories and minerals; group V (NaCl restriction) consumed 40% less sodium chloride than group I, but equivalent amounts of all other nutrients. All groups consumed equivalent amounts of calcium, phosphorus and vitamins. Groups II and III experienced retardation of growth in comparison to groups I, IV and V. The food-restricted groups II and III, but not groups IV and V, had less proteinuria than group I 20 weeks postablation. By 21 weeks postablation, the kidneys from group I showed severe parenchymal damage, characteristic of end-stage renal pathology. These changes were prevented in the food-restricted groups II and III, but not in groups IV and V. The percentage of glomeruli with severe structural damage was less in groups II (27.3 +/- 8.8) and III (26.9 +/- 7.5) compared with group I (72.4 +/- 7.8). In contrast, the corresponding values in groups IV and V were not significantly different from group I. Interstitial volume (the percentage of tubulointerstitium which is interstitium) which was proportional to the severity of tubular damage was significantly lower in groups II (25.1 +/- 4.5) and III (20.4 +/- 2.8) when compared with groups I (48.1 +/- 3.0), IV (44.4 +/- 6.6), or V (41.9 +/- 4.2). An interstitial volume less than 30 correlated with well preserved renal histology, whereas a value greater than 40 was indicative of end-stage renal pathology. These results indicate that the restriction of carbohydrate, fat, and minerals (except for calcium and phosphorus) retarded growth and prevented the development of end-stage renal pathology in the remnant kidney model of chronic renal failure in rats, regardless of whether protein was restricted or not.(ABSTRACT TRUNCATED AT 400 WORDS)
Asunto(s)
Proteínas en la Dieta/administración & dosificación , Ingestión de Energía , Fallo Renal Crónico/prevención & control , Aumento de Peso , Alimentación Animal , Animales , Presión Sanguínea , Peso Corporal , Dieta Hiposódica , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Riñón/patología , Masculino , Minerales/administración & dosificación , Nefrectomía , Ratas , Ratas Endogámicas F344RESUMEN
To simulate hematuria, blood from healthy volunteers was added to urine samples of varying osmolalities to produce urocrits ranging from 0.01 to 3.0%. Specimens were then analyzed for protein concentration by a method using a combination of 3% sulfosalicylic and trichloroacetic acids. Microscopic hematuria (urocrit of less than 0.05%) was not associated with proteinuria, but gross hematuria often resulted in substantial amounts of protein being detected. In iso- and hypertonic urines, modest elevations in protein concentration (69-97 mg/dl) were detected. Hypotonic urines produced marked proteinuria (1,302-1,863 mg/dl). Urine protein electrophoreses identified hemoglobin as the responsible protein. Isolated hematuria can cause false-positive proteinuria on the basis of RBC lysis and release of hemoglobin into the urine. The diagnostic and prognostic implications of clinical proteinuria in the hematuric patient can be significant. Thus, in a patient with gross hematuria, a urine protein electrophoresis should be accomplished to assess the contribution of hemoglobin to the total protein determination.
Asunto(s)
Hematuria/fisiopatología , Hemólisis , Proteinuria/diagnóstico , Reacciones Falso Positivas , HumanosRESUMEN
A patient with unilateral gross hematuria was found to have mesangial proliferation and IgM deposition on renal biopsy, consistent with the entity of primary renal hematuria. This case refutes previous assumptions that renal biopsy is normal in patients with unilateral hematuria. Glomerular lesions may be more common than previously suspected in the setting of unilateral hematuria. Renal biopsy can be useful both to define the natural history of unilateral hematuria and prevent repeated diagnostic procedures in patients with abnormal biopsies.