H. Sponsel et Jd. Conger, IS PARENTERAL-NUTRITION THERAPY OF VALUE IN ACUTE-RENAL-FAILURE PATIENTS, American journal of kidney diseases, 25(1), 1995, pp. 96-102
A patient with oliguric acute renal failure (ARF) following mitral val
ve surgery is presented, The patient was treated with parenteral nutri
tion and hemodialysis. While the patient survived, there were several
complications of nutrition therapy, In this review, the benefits, risk
s, and uncertainties regarding parenteral nutrition in ARF are conside
red. First, the differences in metabolism in complicated and uncomplic
ated acute uremia are discussed, The important roles of alterations in
intermediary metabolism and of proteases in the catabolism of ARF are
emphasized, The historical basis of parenteral nutrition treatment in
ARF is reviewed, The results are divided regarding the relationship a
mong nutritional support, improvement in renal function, and enhanced
patient survival, A critical analysis of nitrogen metabolism results r
eported in the literature does not convincingly support the effectiven
ess of parenteral nutrition formulae in generating positive nitrogen b
alance, The complications of parenteral nutrition therapy are outlined
, In light of the uncertain efficacy and recognized risks of prolonged
parenteral nutrition, a rationale for approaching therapy is presente
d that is based on the estimated metabolic stress and protein-energy r
equirements of the individual ARF patient. (C) 1995 by the National Ki
dney Foundation, Inc.