Dietary Protein in Hemorrhagic Bright's Disease

Abstract

The comparatively few accurate studies of the nitrogen balance which have been made during the chronic active stage of nephritis have been concerned chiefly with the quantitative aspect of the protein requirement (17). Little attention has been given to the kind of protein fed and its effect upon hypoproteinemia, proteinuria and the storage of protein in the tissues.2 The problem of hypoproteinemia is of especial interest, since no satisfactory means of increasing the concentration of the serum proteins of the nephritic has been discovered. Recently a systematic attempt has been made by Whipple and collaborators (10,20) to ascertain factors governing the regeneration of plasma proteins. By repeated plasmapheresis of the dog they have shown the existence of a reserve depot containing precursors of the serum proteins. The quantity of protein released by the depot under the stimulus of depletion was often two or three times greater than the total amount of plasma protein originally present in the circulation. When the reserve had been exhausted the effect of different food proteins on the rate of regeneration was measured. The most satisfactory responses in order of decreasing potency were given by beef serum, smooth muscle, lactalbumin, boiled white of egg, skeletal muscle and liver. Owing to the excellent response of the experimental animal it seemed logical to test the effect of some of these 1Aided by a grant from the Subjects. The major part of the report is devoted to an investigation of two patients. The first was in the degenerative stage of chronic hemorrhagic Bright's disease. The second was a man whose illness was of shorter duration, and closely resembled a true nephrosis. Both patients were studied in the metabolism division of the hospital, where their diets were prepared and sampled in a manner previously described (1).The third patient, also in the degenerative stage of chronic active hemorrhagic Bright's disease, was studied on the general medical division. His diets were prepared in the special diet kitchen of the hospital but were not sampled or analyzed.Diets. The plan of varying the constituents of the diet differed with each subject, which necessitates a separate discussion of each case. In general the plan was to keep each patient on a control (basal) diet, from time to time superimposing the protein to be tested or additional calories in the form of carbohydrate and fat.To provide some variety three menus were prepared for each diet. These varied slightly but had the same caloric and protein content, and were fed consecutively during each three day period. The patients thus ate the same food every third day. All of the diets were prepared without salt.Protein supplements. With one exception, which is discussed under the case of L. R., the protein supplements 871

The Influence of Diet Upon the Regeneration of Serum Protein

“…Certainly with respect to the proteins here tested, the potency ratios are not so widely different as to warrant the administration of any one protein in preference to another. This conclusion is supported by the observations of Keutmann and Bassett (16), who applied the findings of Whipple and associates in feeding three patients with degenerative Bright's disease. No really distinct, significant differences were detected in the effect of the protein supplements tested.…”

The Influence of Diet Upon the Regeneration of Serum Protein

“…In evaluating these dietary changes the potency ratio was assumed to be independent of the amount of protein in the diet. However, it has been shown that the coefficient of utilization of an essential dietary component, in this case the protein (7)(8)(9), decreases when an excess of the substance is fed. 5.…”

Low Protein Diet Augments Hyperproteinemia Produced by Repeated Injections of Homologous Plasma

“…Liu and Chu (11), Keutmann and Bassett (12), and Farr (13) have all found an "optimum" intake of about 3.0 gin. of protein per kg.…”