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- W2000958826 abstract "A 33-year-old man was first examined at the age of 23 years. He was admitted to the Universith Degli Studi di Napoli hospital because a routine laboratory evaluation prior to an appendectomy had shown a BUN of 55 mg/dl. His hearing had been impaired since birth, and he had a 4-year history of polyuria and nocturia; macroscopic hematuria had never been noted. His father had died at age 54 of chronic cor pulmonale, and his mother had diabetes mellitus. Of a total of 11 brothers, 9 were alive and well; 2 had died in the first year of life of unknown causes. All family members were of normal stature. There was no family history of deafness. On physical examination at age 23, the height was 154 cm and the weight was 38 kg; there were no malformations. Blood pressure was 120/80 mm Hg. Funduscopic examination was normal. Cardiac examination revealed a precordial thrust and a grade 11/Vt apical systolic murmur but was otherwise unremarkable. The testicles were well formed but small. There were no neurologic deficits. The remainder of the examination was unremarkable. Urinalysis revealed the following: specific gravity, 1.009; pH, 5; 1+ protein; and 2 to 3 white blood cells per high-power field. The urine culture was negative on three occasions. Other values included: BUN, 50 mg/dl; glucose, 80 mg/dl; hemoglobin, 13.5 g/dl; sodium, 139 mEqI liter; potassium, 4.6 mEq/liter; bicarbonate, 18 mEq/liter; calcium, 9 mg/dl; and phosphorus, 4.4 mg/dl. Serum alkaline phosphatase was 40 mU/mI (normal <70 mU/mi); uric acid, 6 mg/dl; plasma proteins, 7.0 g/ dl (60% albumin); serum creatinine, 3 mg/dl; creatinine clearance, 28 mI/mm per 1.73 m2; triglycerides, 200 mg/dl, and cholesterol, 180 mg/dl. An electrocardiogram showed mild left ventricular hypertrophy. A chest x-ray revealed no cardiac abnormalities, but some calcified lymph nodes were seen in the right mid-thoracic region. An audiogram disclosed bilateral hearing deficits, more severe on the left. Renal tomography revealed the left kidney to be 9 cm and the right kidney to be 6 cm long. An intravenous pyelogram showed no obstruction. A renal biopsy revealed changes consistent with membranoproliferative glomerulonephritis. Plasma essential amino acids were normal but there were increased concentrations of Iand 3-methyl-histidine and decreased concentrations of tyrosine and proline. The tyrosine/phenylalanine ratio was reduced, but the ratio of the concentrations of essential and nonessential amino acids was normal (Table I). A low-protein diet providing 0.45 g/kg of high-quality protein was prescribed. Emphasis was placed on egg yolk, cheese, rice, and shrimp. with meat or whole egg as alternatives. The patient was allowed to double his daily protein intake once a week. The energy content of the diet of 188 kj/kg was derived mainly from carbohydrates: the ratio of energy derived from carbohydrates to that from fats was 3:1. Vitamin supplements were provided daily; phosphate binders were not used. While the patient was ingesting this diet, nitrogen balance was positive (Fig. 1). The patient was seen bimonthly in the outpatient department. A dietician visited him every 2 to 3 months to ensure adherence to the prescribed diet. All reports suggested that the patient was complying with the prescriptions and that his mother had been employing various techniques to avoid dietary monotony. The diet was changed every season so that the patient could have his usual foods as well as many kinds of green vegetables. He also was given a dietary plan designed to avoid his having to eat the same meal more than 4 times per month. The patient worked as a barber and was completely asymptomatic. Laboratory data 2 years after the initial hospital admission revealed that the creatinine clearance was still 27 mI/mm. the serum creatinine was 3.2 mg/dl, and the BUN was 20 mg/dl. When the patient was examined 2 years later, the blood pressure was 140/80 mm Hg, the creatinine clearance was 16 mI/mm, the BUN was 28 mg/dl, and the serum creatinine was 6 mg/dl. At that time, his protein intake was decreased to 0.38 g/kg body weight. Evaluation 2 years later (6 years after his first evaluation) revealed a blood pressure of 140/80 mm Hg, a BUN of 27 mg/dl, and a serum creatinine of 6.2 mg/dl. The patient was rehospitalized 2 years later at age 31, 8 years after his first admission. His blood pressure was 140/80 mm FIg and a funduscopic examination was normal. The remainder of the physical examination" @default.
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- W2000958826 date "1982-10-01" @default.
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- W2000958826 title "Protein restriction in chronic renal failure" @default.
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- W2000958826 doi "https://doi.org/10.1038/ki.1982.189" @default.
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