Serum Amino Acids Concentration and Nitrogen Balance in Patients with Chronic Renal Failure

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The Department of Medicine, Medical School, Osaka University Recently, attention has been drawn to hypoprotein diet therapy on patients with chronic renal failure, because hemodialysis management could attain a good clinical result with an adequate hypoprotein diet therapy. But, it still remains not clarified whether any difference in amino acid metabolism and renal tubular transport exists between patients with chronic renal failure and healthy subjects. This study aims to clarify any difference in serum amino acids concentration in the patients with chronic renal failure and an effective nitrogen balance therapy using essential amino acid transfusion under the hypoprotein fed patients. Material and Method; 1) Blood was obtained from 11 patients with chronic renal failure (BUN 33-149 mg/dl, protein 25-40g fed) and 10 healthy subjects (20-35 years old) after 10 hours fasting. Serum amino acids concentration was dertermined by a Yanagimoto Amino Acids Autoanalyser. 2) A 2 weeks' essential amino acid transfusion was given (5%, 200ml) daily to the subject H. N.(BUN 95mg/dl, protein 13g fed). During the 2 weeks' amino acid transfusion and five days pre and post therapeutic stages, daily nitrogen output has been estimated by measurement of daily urinary nitrogen excretion and by using the amount of fecal nitrogen excretion reported by Prof. Koishi.(under the hypoprotein diet stage, 0.77g/day.) Then, a nitrogen balance was obtained. Serum creatinine, BUN and other clinical and chemical examinations were carried out. Results 1) Valine, leucine, methionine, serine and tyrosine in the patients with chronic renal failure were in serum concentration significantly lower than those in the healthy subjects, respectively. Glutamic acid, taurine and asparatic acid in the patients with chronic renal failure were in serum concentration significantly higher than those in the healthy subjects, respectively. There were no significant differences in other serum amino acids concentration. Phenylalanine/tyrosine ratio was increased in all the patients, as reported by Josephson, Shear and Loeper. 3-methyl histidine was found in all the patients, but not in the healthy subjects. There was no correlation between an individual amino acid concentration, total amino acids concentration and BUN. 2) Transfusion of essential amino acids solution brought out a positive nitrogen balance and lowering of BUN, leading to comfortable physical condition. Discussion Some differences in serum amino acids concentration were observed between the patients with chronic renal failure and the healthy subjects. However, a complete agreement with the previous reports could not be obtained. This would be resulted from the differences in the measurement technique, the diet or the renal amino acid transport mechanism. Toxicity of 3- methyl - histidine should be examined. As already reported by Giovanetti and others, essential amino acid transfusion on the patient with chronic renal failure under hypoprotein diet brought out a good clinical result. A more practical device should be arranged on nitrogen nutrition in patients with chronic renal failure. Summary Serum amino acids concentration in patients with chronic renal failure was examined and some. differences were found out in comparison with that in healthy subjects. A positive nitrogen balance was obtained by transfusion of essential amino acid in the patients with chronic renal failure.
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Serum Amino Acids Concentration and Nitrogen Balance in Patients with Chronic Renal Failure

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