CIN '2007 - 4º CONGRESO DE NEFROLOGIA EN INTERNET
High creatinine excretion rate: A sign of a catabolic state
Dr Ana Paula de Carvalho Panzeri Carlotti, Dr Desmond Bohn, Dr Alessandra Kimie Matsuno, Dr Dulceléia da Mata Pasti, Dr Manjula Gowrishankar, Dr Mitchell Lewis Halperin
Renal Division, St. Michael's Hospital, University of Toronto. Ontario
Abstract
The major stress response to critical illness leads to a catabolic state and loss of lean body mass. Our objective was to test whether an increased rate of creatinine excretion might provide unique and timely information to indicate that cell catabolism was present and to verify this information by measurements of nitrogen balance. A second objective was to evaluate the effectiveness of nutritional therapy to reverse this catabolic process. The study design was a prospective, observational study in 17 children with severe traumatic brain injury over 3-10 days in the ICU. On day 1, all had negative balances for protein, but balances for protein became positive when protein intake was ≥ 1 g/kg/d and energy intake was ≥ 50% of estimated energy expenditure (p<0.0001). Of great interest, creatinine excretion rate was positively correlated with the urea appearance rate (r=0.60; p<0.0001), and negatively with protein balance (r = -0.45; p < 0.0001). Sepsis developed in four patients; before its clinical detection, there were negative balances for protein and an abrupt rise in the excretion of creatinine. We conclude that an increase in rate of creatinine excretion heralded the onset of catabolism; this may reflect the entry of the precursor of creatinine, L-arginine, into the systemic circulation.Comentarios :