A 38-year-old woman, obese (219 kg), diabetic, hypertensive, chronic kidney disease (CKD) stage 4, with low plasma albumin level (2.9 g dl(-1)) and marked proteinuria (22 g per day) was studied. Given the advanced-stage CKD with nephrotic proteinuria, we supplemented low-protein diet with high doses of a tailored essential amino acid mixture (AAs: 44 g per day) to improve weight reduction in the patient. After 20 months of conservative therapy, the patient lost 43 kg; despite two episodes of infection, albumin plasma levels increased up to 3.7 g per day. After a further 20 months of dialysis, the patient maintained a diet of 1800 kcal supplemented with 32 g of AAs and lost 47 kg, whereas both albumin (3.89±0.12 g dl(-1)) and C reactive protein returned to normal. During the follow-up period, anemia improved, erythropoietin was thus discontinued and insulin requirement decreased to 105 IU. This therapeutic option may be beneficial in advanced CKD patients with obesity and diabetes resulting from malnutrition.
|Titolo:||Morbid obesity in a young woman affected by advanced chronic kidney disease: an exceptional case report. Does a high dose of essential amino acids play a key role in therapeutic success?|
|Parole Chiave:||adult; amino acids, essential; amphetamine; anemia; body mass index; c-reactive protein; diet, protein-restricted; dietary supplements; energy intake; erythropoietin; female; follow-up studies; glomerular filtration rate; humans; hypertension; obesity, morbid; patient compliance; proteinuria; quality of life; renal insufficiency, chronic; serum albumin; treatment outcome; waist circumference; internal medicine; endocrinology, diabetes and metabolism|
|Settore Scientifico Disciplinare:||Settore MED/09 - Medicina Interna|
|Data di pubblicazione:||feb-2016|
|Digital Object Identifier (DOI):||10.1038/nutd.2016.4|
|Appare nelle tipologie:||01 - Articolo su periodico|