Robert H Herman Memorial Award in Clinical Nutrition Lecture, 1997. Mechanisms causing loss of lean body mass in kidney disease.

摘要: Loss of lean body mass is common in patients with acute or chronic renal failure but the mechanisms causing this loss are only beginning to be understood. One mechanism involves an inability uremic activate critical metabolic responses that maintain protein balance when dietary limited. Metabolic restriction include a sharp reduction degradation essential amino acids and protein; changes synthesis less reliable. If uremia prevents suppression acid reduced by anorexia, negative nitrogen will ensue. complication uremia, acidosis, stimulates branched-chain proteins therefore blocks ability patient respond low-protein diet. The require glucocorticoids involve increased activity keto dehydrogenase ubiquitin-proteasome proteolytic pathway; there also transcription genes encoding components enzymes involved pathways. Besides low insulin concentration cytokines pathway. Understanding how proteolysis activated, including these stimulated, important because same pathways activated diabetes, cancer, sepsis, burns, starvation, muscle denervation. Activation pathway leads mass.