The effects of therapy with essential amino acids and their nitrogen-free hydroxy and keto precursers on nitrogen and amino acid metabolism of patients with chronic renal failure were examined. Data obtained under treatment with essential amino acids and alpha-keto acid analogues showed higher levels of plasma amino acids, C3-complement, and transferrin than with a low-protein diet alone. Nitrogen balance became positive and plasma urea levels fell. With keto acid analogue therapy, these effects could be obtained with a reduced nitrogen intake. Supplementation of a low protein diet with alpha-hydroxy acid analogues was associated with more positive nitrogen balance and a rise in plasma histidine and methionine. However, plasma levels of three other essential amino acids fell.

In 26 patients (8 women, 18 men; mean age 47 +/- 3 years) who participated in a regular dialysis programme twice weekly the left ventricular diameter, the mean velocity of fibre shortening, the ventricular wall thickness, and the muscle mass were determined echocardiographically. Left ventricular muscle mass (187 +/- 13 g), left ventricular posterobasal wall thickness (14,7 +/- 0,6 mm) and septal thickness (16,4 +/- 0,8 mm) were pathologically increased due to chronic pressure and volume overloading. After an average dialysis time of 12 hours the body weight was reduced by 2,6 +/- 0,4 kg (+ 1,0 to -7,8 kg). The left ventricular transverse diameter changed from 55,3 to 50,2 mm (P less than 0,001) which correlated with a decrease of the enddiastolic volume from 160 +/- 11 to 125 +/- 10 ml (P less than 0,01(. Despite increased cardiac frequency and unchanged diastolic and systolic pressure no significant increase of the mean velocity of fibre shortening (0,93 +/- 0,06 vector 1,13 +/- 0,09 circ/s) occurred. The results show that loss of fluid during haemodialysis led to a significant decrease of the enddiastolic transverse diameter and the enddiastolic left ventricular volume. However, dialysis does not lead to an increase of the mean velocity of fibre shortening as a parameter of improved contractility.

The diagnosis of paraproteinaemic coma was made in 5 out of 74 patients with plasmocytoma. Compared with the other patients these 5 showed a nearly twofold increase of total serum and CSF protein concentration, a higher percentage of plasma cells in sternal marrow and extreme hypergamma-globulinaemia in the immunoelectrophoresis. In both groups CSF and serum amino acid concentrations showed no pathological changes. Psychopathologically the patients with paraproteinaemic coma showed the picture of an exogenous psychosyndrome. Electroencephalography demonstrated moderate general disturbances.

No abstract

No abstract