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Prevention of Prednisone-lnduced Negative Nitrogen Balance: Effect of Dietary Modification on Urea Generation Rate in Patients on Hemodialysis Receiving High-Dose Glucocorticoids

MARTIN G. COGAN, M.D.; JOHN A. SARGENT, Ph.D.; SUSAN G. YARBROUGH, M.S., R.D.; FLAVIO VINCENTI, M.D.; and WILLIAM J. AMEND Jr., M.D.
[+] Article and Author Information

Portions of this work have appeared in abstract form (Kidney Int. 1979;16:951. Abstract).

▸Requests for reprints should be addressed to Martin G. Cogan, M.D.; Division of Nephrology, 1065 HSE, University of California; San Francisco, CA 94143.


San Francisco, California


© 1981 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1981;95(2):158-161. doi:10.7326/0003-4819-95-2-158
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To assess whether increasing dietary protein and calorie intake can ameliorate the negative nitrogen balance induced by 70 to 120 mg/d prednisone, we studied nitrogen intake and net urea generation rate in patients undergoing hemodialysis for 10 to 14 days after renal transplantation. Seven patients receiving prednisone with moderately restricted protein (0.73±0.03 g/kg of body weight per day) and calorie (20±4 kcal/kg of body weight per day) intake had high urea nitrogen generation rates (199±18 mg/kg • d) and protein catabolic rates (1.45±0.12 g/kg • d) and were in marked negative protein balance (-0.72±0.12 g/kg ± d). An increase in protein (1.30±0.06 g/kg • d) and calorie (33±3 kcal/kg • d) consumption in another eight prednisone-treated patients resulted in protein balance (-0.02±0.12 g/kg • d) without further increasing urea generation (174±9 mg/kg • d). Six control patients undergoing hemodialysis after surgery who were not receiving prednisone had lower urea generation rates (109±15 mg/kg • d) and were in nitrogen balance. Nitrogen wasting is therefore not an inevitable consequence of high-dose glucocorticoid therapy and can be effectively prevented by simple nutritional modification without increasing hemodialytic requirements.

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