Proteolytic activity in patients with hypercatabolic renal failure.

Area of Science:

• Nephrology
• Biochemistry
• Enzymology

Background:

• Proteolytic enzymes are present in patients with posttraumatic renal failure.
• Differences in enzyme activity suggest varying proteases in hypercatabolic states.
• Trypsin binding capacity is notably reduced in patients undergoing renal replacement therapy (RRT) and acute renal failure (ARF).

Purpose of the Study:

• To investigate the characteristics of proteolytic enzymes in patients with posttraumatic renal failure.
• To compare enzyme profiles between different types of renal failure.
• To evaluate the efficacy of fresh frozen plasma versus plasma protein solutions and the impact of hemodialysis on protein catabolism.

Main Methods:

• Analysis of ultrafiltrated plasma, dialysates, and urine fractions.
• Assessment of phosphorylase kinase digestion patterns.
• Measurement of trypsin binding capacity.
• In vitro inhibition studies using alpha 2-macroglobulin.

Main Results:

• Distinct proteolytic enzymes were identified in patients with posttraumatic renal failure.
• Reduced trypsin binding capacity was observed in RRT and ARF patients.
• Alpha 2-macroglobulin inhibited protein catabolism in vitro.
• Hemodialysis may increase plasma proteinase inhibitory capacity, including E-X1 PI.
• Continuous release of granulocyte elastase during hemodialysis is noted.

Conclusions:

• Fresh frozen plasma is recommended over plasma protein solutions for hypercatabolic patients.
• Hemodialysis may enhance the plasma's proteinase inhibitory capacity.
• Potential risk for destructive lung disease due to granulocyte elastase release during hemodialysis warrants consideration.