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Nutritional status and muscle amino acids in children with end-stage renal failure
A Canepa1, J C Divino Filho, A M Forsberg
1Nephrology Department, Istituto Giannina Gaslini, Genova, Italy.
Insights
Children with chronic renal failure (CRF) may have normal nutritional status but show abnormal amino acid levels. Growth retardation in pediatric CRF is linked to these specific amino acid imbalances.
Area of Science:
- Pediatric Nephrology
- Clinical Nutrition
- Biochemistry
Background:
- Chronic renal failure (CRF) in children often leads to growth retardation.
- Assessing nutritional status in pediatric CRF is crucial for management.
- Uremia can impact protein and amino acid metabolism.
Purpose of the Study:
- To evaluate nutritional status, body composition, and muscle/plasma amino acid profiles in children with end-stage CRF.
- To compare these parameters between children with CRF and healthy controls.
- To identify specific amino acid abnormalities associated with pediatric CRF and growth retardation.
Main Methods:
- Anthropometric measurements (height, weight, skinfold thickness, arm muscle circumference) and biochemical assessments (serum proteins).
- Analysis of rectus abdominis muscle composition (water, protein, DNA, alkali-soluble protein).
- Measurement of plasma and muscle amino acid levels using chromatographic techniques.
Main Results:
- Uremic children showed reduced height and body weight but normal serum proteins and muscle composition (water, protein, DNA).
- Significant decreases in plasma essential amino acids (leucine, isoleucine, valine, serine) and increases in certain non-essential amino acids (citrulline, methylhistidines) were observed in uremic children.
- Muscle isoleucine and valine levels, along with the valine/glycine ratio, were lower in children with CRF.
Conclusions:
- Children with CRF and growth retardation can maintain seemingly adequate nutritional status based on standard anthropometric and biochemical markers.
- Despite normal overall nutritional status, significant abnormalities in plasma and muscle amino acid profiles are characteristic of pediatric uremia.
- These amino acid imbalances are likely contributors to growth retardation in children with chronic renal failure.
Abstract:
Nutritional status, assessed by anthropometric and biochemical methods, and muscle water, protein and amino acid composition, were evaluated in a control group of 10 children with normal renal function who were undergoing elective surgery, and in 15 children with end-stage chronic renal failure. Samples of the rectus abdominis muscle were taken when surgery was performed in the control children and when a peritoneal catheter was implanted in the uremic children. Height and body weight were reduced in the uremic children compared to the controls but skinfold thickness, arm muscle circumference and serum proteins (total protein, albumin, transferrin, pseudocholinesterase) were essentially normal. The muscle contents of total, extracellular and intracellular water, and of alkali-soluble protein (ASP), DNA and the ASP-DNA ratio were not significantly different in uremic children from those in the controls. Plasma leucine, isoleucine, tyrosine, valine, and serine levels were significantly decreased, whereas plasma citrulline, 1-methylhistidine and 3-methylhistidine levels were increased. Muscle isoleucine and valine levels and the valine/glycine ratio were low in the uremic children. Our results demonstrate that children with chronic renal failure and growth retardation may maintain a satisfactory nutritional status but exhibit amino acid abnormalities typical of uremia.