Kidney disease, chronic protein metabolism

Major differences exist between the metabolic, fluid, and electrolyte management of patients with acute versus chronic kidney disease (CKD). For example, positive nitrogen balance is more difficult to achieve in patients with acute renal failure (ARF) due to the increased rate of protein catabolism. Additionally, patients with acute renal failure are more likely to develop hyperglycemia during nutritional support and frequently are dialyzed by modalities that are not used commonly for the patient with end-stage kidney disease (ESKD). Because of these differences, the nutritional management of patients with ARF is discussed separately. 

This is what happened in the Jinzu River basin as locally grown rice became contaminated with cadmium. Dietary exposure was high as rice was the staple diet of most local people and as a result of chronic exposure to cadmium in the diet many began to suffer bone disease and abnormalities of calcium metabolism and kidney problems, a condition that known locally as itai-itai disease (literally translated as ouch ouch ).38 This disease became most apparent during and immediately after the Second World War with elderly women, particularly women who had given birth to several children, most affected. During this period, food was scarce and the diets of local people became extremely heavily dependent on rice. In addition, the scarcity of food meant that the diet of many people was also deficient in calcium, vitamin D and protein. These factors exacerbated the toxicity of cadmium, and in a relatively small area over two hundred elderly women were severely affected, many of whom eventually died as a result of this condition. It has since been estimated that people in the Jinzu River basin had a... 

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