title: Morbid obesity in a young woman affected by advanced chronic kidney disease: an exceptional case report. Does a high dose of essential amino acids play a key role in therapeutic success?
abstract: A 38-year-old woman, obese (219 kg), diabetic, hypertensive, chronic kidney disease (CKD) stage 4, with low plasma albumin level (2.9 g dl(-1)) and marked proteinuria (22 g per day) was studied. Given the advanced-stage CKD with nephrotic proteinuria, we supplemented low-protein diet with high doses of a tailored essential amino acid mixture (AAs: 44 g per day) to improve weight reduction in the patient. After 20 months of conservative therapy, the patient lost 43 kg; despite two episodes of infection, albumin plasma levels increased up to 3.7 g per day. After a further 20 months of dialysis, the patient maintained a diet of 1800 kcal supplemented with 32 g of AAs and lost 47 kg, whereas both albumin (3.89±0.12 g dl(-1)) and C reactive protein returned to normal. During the follow-up period, anemia improved, erythropoietin was thus discontinued and insulin requirement decreased to 105 IU. This therapeutic option may be beneficial in advanced CKD patients with obesity and diabetes resulting from malnutrition.
authors.affiliation: S.C. Territoriale di Nefrologia e Dialisi, ASL Cagliari, Quartu Sant'Elena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Caria
authors.affiliation: S.C. Territoriale di Nefrologia e Dialisi, ASL Cagliari, Quartu Sant'Elena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Murtas
authors.affiliation: Anestesia e Rianimazione, Ospedale Marino, ASL Cagliari, Quartu Sant'Elena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Loria
authors.affiliation: Dipartimento di Scienze Cliniche e di Comunità-Università degli Studi Milano, Milano, Italy.
authors.forename: F S
authors.initials: FS
authors.lastname: Dioguardi
authors.affiliation: S.C. Territoriale di Nefrologia e Dialisi, ASL Cagliari, Quartu Sant'Elena, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Secci
authors.affiliation: S.C. Territoriale di Nefrologia e Dialisi, ASL Cagliari, Quartu Sant'Elena, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bolasco
mesh_terms: D000328:Adult; D000601:Amino Acids, Essential / Q000008:administration & dosage* / Q000097:blood; D000661:Amphetamine / Q000008:administration & dosage; D000740:Anemia / Q000188:drug therapy; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D018753:Diet, Protein-Restricted; D019587:Dietary Supplements; D002149:Energy Intake; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy; D009767:Obesity, Morbid / Q000150:complications / Q000188:drug therapy*; D010349:Patient Compliance; D011507:Proteinuria / Q000097:blood / Q000150:complications / Q000188:drug therapy; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome; D055105:Waist Circumference
chemical_list: D000601:Amino Acids, Essential; D012709:Serum Albumin; D004921:Erythropoietin; D002097:C-Reactive Protein; D000661:Amphetamine