title: Restricted protein diet is associated with decrease in proteinuria: consequences on the progression of renal failure.
abstract: OBJECTIVE
  Reduction of proteinuria is associated with a slower progression of renal failure. We questioned whether the change in proteinuria in response to a supplemented very low protein diet (SVLPD), which is known to reduce proteinuria, could function as a marker of the potential renoprotective effect of an SVLPD.
  
  
  METHODS
  In the 220 consecutive patients of our previously published cohort, the glomerular filtration rate (GFR) was assessed every 3 months using the (51)Cr-EDTA method. Seventy-eight patients (mean age 52 +/- 17 years, body mass index 23 +/- 3 kg/m(2), GFR 15 +/- 6 mL/min) exhibited a proteinuria more than 1 g per day at the start of the regimen. Mean protein intake assessed by urinary nitrogen appearance was 0.42 +/- 0.24 g/kg per day at 4 months. The median follow-up was 24 months.
  
  
  RESULTS
  Proteinuria decreased significantly after patients were treated with an SVLPD. The maximum mean percent reduction was attained at 3 months (47% +/- 27%), was not influenced by the levels of baseline proteinuria, and was similar in patients receiving or not receiving angiotensin-converting enzyme inhibition at the start of the study. The percent reduction and the residual proteinuria at 3 months predicted the rate of the later GFR decline. GFR decline was significantly lower in patients whose reduction in proteinuria at 3 months was higher than 50% (0.42 +/- 0.37 mL/min/mo vs. 0.10 +/- 0.15 mL/min/mo and 1.0 +/- 0.6 mL/min/mo vs. 0.15 +/- 0.19 mL/min/mo, P < .001 in patients with proteinuria higher or lesser than 3 g/d at start, respectively).
  
  
  CONCLUSIONS
  These results do not differ from those reported with therapies antagonizing angiotensin II formation and/or activity aiming at reducing proteinuria in chronic renal diseases.
authors.affiliation: Département de Néphrologie, Hôpital Pellegrin, France. ph.chauveau@wanadoo.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Chauveau
authors.forename: Christian
authors.initials: C
authors.lastname: Combe
authors.forename: Vincent
authors.initials: V
authors.lastname: Rigalleau
authors.forename: Benoit
authors.initials: B
authors.lastname: Vendrely
authors.forename: Michel
authors.initials: M
authors.lastname: Aparicio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018753:Diet, Protein-Restricted; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000178:diet therapy* / Q000453:epidemiology*; D051437:Renal Insufficiency / Q000178:diet therapy* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors