[Nutritional factors in the development of experimental renal failure]

Several experimental studies have shown that the development of glomerular sclerosis during aging in rats is related to nutritional factors: it is impeded by overall food restriction, as well as by reduction of the protein, carbohydrate or sodium intake. It is enhanced by high protein or high sodium diets. In remnant kidneys, lesions develop that are similar to those in aging kidneys and that seem to be influenced by the same factors. Through several experiments, we have shown that the rapidity of the deterioration of renal function after subtotal nephrectomy is closely related to the protein intake and that the length of survival can be reduced by a high protein diet or increased by a low protein diet. The influence of protein intake remains clearly apparent when the intake of all other nutrients, particularly minerals, and of calories is strictly controlled. Low protein diets supplemented with essential amino acids resulting in increased appetite are of little benefit for survival, suggesting that the calorie intake or growth-related factors may be of significance. Prolonged survival observed with phosphorus (P) deficient diets compared to low or normal P diets is mainly due to decreased appetite. The optimal supply of protein, energy, sodium and other nutrients should be determined according, not only to nutritional status, but also to effects on the renal parenchyma.