WHICH AMINO-ACIDS DO SERUM AND HEMOFILTRATE OF CRITICALLY ILL PATIENTS WITH ACUTE-RENAL-FAILURE CONTAIN

The removal of amino acids during continuous renal replacement therapi es induces clinical problems. Previous studies on animals have shown n ephroprotective (glycine, alanine) or negative effects (lysine) on ren al function in occurrence of acute renal failure. Disturbed metabolism in acute renal failure needs adequate parenteral nutrition. On the ot her hand, experience with continuous renal replacement therapies of me tabolic crises in inborn errors of metabolism indicate a good control of disturbed amino acid metabolism. The aim of our study was to find a mino acids, that might play an important role in the pathogenesis, pro gnosis and detection of acute renal failure and severe illness, so far only estimated by lactic acid. Thirty-three probes (serum and hemofil trate) were taken from patients, suffering with acute renal failure ca used by septic shock, severe pancreatitis and hepatorenal syndrome, on e hour after the beginning of extracorporal circulation, the condition s of treatment were standardized The material was deproteinized and st udied by the amino acid analyzer LBK 4251 Apha Plus (Pharmacia, Stockh olm, Sweden), while the lactic acid concentration was determined in a standard laboratory. Proline, glycine, alanine, methionine and histidi ne showed a close relationship to the lactic acid levels, but these am ino acids were an essential part of parenteral nutrition. A statistica l relationship was also established in (amino acids with amide groups) asparagine, glutamine, citrulline, cystathionine and phosphoethanolam ine. The mean values of most of the amino acids were higher than norma l, but standard deviations were increased. The presence of these amino acids in hemofiltrate and the good sieving coefficients could mean th at the better prognosis of critically ill patients in continuous renal replacement therapies may also be due to continuous control of amino acid levels (especially with amide groups).