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Carnitine and carnitine esters in acute renal failure
C Wanner1, W Riegel, R M Schaefer
1Department of Medicine, University Hospital of Freiburg, FRG.
Summary
Patients with acute renal failure exhibit elevated carnitine levels, regardless of sepsis or dialysis. Liver carnitine synthesis increases in acute kidney injury, suggesting no need for supplementation in well-nourished patients.
Area of Science:
- Biochemistry
- Nephrology
- Metabolic Disorders
Background:
- Elevated plasma carnitine and acylcarnitine concentrations are observed in acute renal failure (ARF).
- The source and regulation of these elevated levels in ARF remain unclear, particularly the roles of the liver and kidneys.
Purpose of the Study:
- To investigate plasma carnitine and carnitine ester levels in ARF patients with and without sepsis, before and after hemodialysis.
- To determine the contribution of the liver and kidneys to carnitine and carnitine ester accumulation in ARF using an animal model.
Main Methods:
- Clinical study measuring plasma total carnitine, free carnitine, short-chain acylcarnitine, and long-chain acylcarnitine in ARF patients and controls.
- Animal study using acutely uraemic rats (ureter ligation, nephrectomy) to assess liver and kidney carnitine metabolism.
Main Results:
- ARF patients showed markedly elevated plasma carnitine and acylcarnitine levels compared to healthy and chronically uraemic subjects.
- Septic status and hemodialysis (cuprophane, polysulphone) did not significantly alter carnitine levels in ARF patients.
- Rat models demonstrated significantly increased liver carnitine synthesis and acylation in ARF, independent of kidney function and food intake.
Conclusions:
- Acute renal failure is associated with significantly increased liver carnitine synthesis and acylation.
- Carnitine supplementation is likely unnecessary for adequately nourished ARF patients, even those requiring daily hemodialysis.