Figure 1825

A, B, Impact of nutritional interventions on renal function and course of acute renal failure (ARF). Starvation accelerates protein breakdown and impairs protein synthesis in the kidney, whereas refeeding exerts the opposite effects [49]. In experimental animals, provision of amino acids or total parenteral nutrition accelerates tissue repair and recovery of renal function [50]. In patients, however, this has been much more difficult to prove, and only one study has reported on a positive effect of TPN on the resolution of ARF [51].

Infusion of amino acids raised renal cortical protein synthesis as evaluated by 14C-leucine incorporation and depressed protein breakdown in rats with mercuric chloride-induced ARF [49]. On the other hand, in a similar model of ARF, infusions of varying quantities of essential amino acids (EAA) and nonessential amino acids (NEAA) did not provide any protection of renal function and in fact increased mortality [52]. However, in balance available evidence suggests that provision of substrates may enhance tissue regeneration and wound healing, and potentially, also renal tubular repair [49]. (From Toback et al. [50]; with permission.)

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