Figure 1826

Impact of nutritional interventions on renal function in acute renal failure (ARF). Amino acid infused before or during ischemia or nephrotoxicity may enhance tubule damage and accelerate loss of renal function in rat models of ARF. In part, this therapeutic paradox [53] from amino acid alimentation in ARF is related to the increase in metabolic work for transport processes when oxygen supply is limited, which may aggravate ischemic injury [54]. Similar observations have been made with excess glucose infusion during renal ischemia. Amino acids may as well exert a protective effect on renal function. Glycine, and to a lesser degree alanine, limit tubular injury in ischemic and nephrotoxic models of ARF [55]. Arginine (possibly by producing nitric oxide) reportedly acts to preserve renal perfusion and tubular function in both nephro-toxic and ischemic models of ARF, whereas inhibitors of nitric oxide synthase exert an opposite effect [56,57]. In myoglobin-induced ARF the drop in renal blood flow (black circles, ARF controls) is prevented by L-arginine infusion (black triangles) [57]. (From Wakabayashi et al. [57]; with permission.)

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