Kidney disease protein requirements

Water Excess. Sometimes excessive water accumulates in the tissues, specifically the interstitial compartment. Outwardly, this condition is noted as swelling and it may occur in any area of the body. It is called edema, though some may still call it dropsy. In general, there are four causes of edema (1) elevated fluid pressure in the capillaries as in heart failure (2) low osmotic pressure in the blood due to decreased blood protein in such conditions as liver cirrhosis, kidney disease, severe burns, and starvation (3) blockage of the lymph vessels as caused by the parasitic worm, filariae, in the disease elephantiasis or (4) increased capillary permeability due to the release of histamine in allergic reactions. Edema may require the restriction of dietary sodium and/or diuretics. 

Amino acids promote the production of proteins, enhance tissue repair and wound healing, and reduce the rate of protein breakdown. Amino acids are used in certain disease states, such as severe kidney and liver disease, as well as in TPN solutions. (See the last section of this chapter for a more detailed discussion of TPN.) TPN may be used in patients with conditions such as impairment of gastrointestinal absorption of protein, in patients with an increased requirement for protein, as seen in those with extensive bums or infections, and in patients with no available oral route for nutritional intake ... 

Erythropoietin [ery throw PO eetin] is a glycoprotein, normally made by the kidney, that regulates red cell proliferation and differentiation in bone marrow. Human erythropoietin, produced by recombinant DNA technology, is effective in the treatment of anemia caused by end-stage renal disease, anemia associated with HIV-infected patients, and anemia in some cancer patients. Supplementation with iron may be required to assure an adequate response. The protein is usually administered intravenously in renal dialysis patients, but in others the subcutaneous route is preferred. Side effects such as iron deficiency and an elevation in blood pressure occur. [Note The latter may be due to increases in peripheral vascular resistance and/or blood viscosity.]... 

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