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High Protein Diets For Kidney Patients

by amymatthews - October 21, 2009

Okay, I feel like one of those kids at school who keeps badgering the teacher...! Can I just say again that it's great to have your experience to turn to?!

I'm being forced to confront the question of high protein diets being good for patients with kidney issues, as one of my lymphoma patients (who has been doing great for a year) recently developed azotemia (not really symptomatic, and he's had chronic dilute urine for years, and he's been off and on peroxicam for forelimb lameness recently). The primary vet, who is a forceful personality, really supports low protein diets. He'll talk to me and listen to me, but he'll be a tough one to crack! I've had a look at Ken Bovee's abstract (wish is was the article, Susan Wynn has ordered and promises to review) from 1990 that suggests that histologically high protein diets don't damage the kidneys. Do you have some experience "from the trenches" about how your patients do with high protein diets? (and, presumably, herbal support)

Thanks again!
Amy

by naturevet

October 23, 2009

Hi again,

I find if vets are dead set against some concept, then it's useless to try to convince them otherwise. I would say if the kidneys continue to decline, you suggest to the owner (whom I'm guessing you converse with as well) that she request of the other vet that they try higher (not excessively high) protein diets. As far as I can tell, there are two forms of renal damage - ischemic and inflammatory. Given the azotemia that has developed on the metacam, I'd suspect ischemia. If urine protein creatinine ratio is less than 1, this supports ischemia. If urine pr/cr is very high, it supports inflamatory lesions. In that case, higher protein diets can be deleterious (but aren't always - e.g. in Damp animals). If ischemia is the problem, and if Rehmannia is being used to avoid renal hypertension, there's just no reason to avoid higher protein levels. They then improve renal blood flow, and do not cause hyperphosphatemia, since the kidneys are the organ that clear excess phosphorus. If you've improved renal blood flow, phosphorus declines and does not increase.

There are scads of studies in the literature now showing that, at the very least, it is very divided, and that appropriate diet depends on circumstances (e.g. ischemia vs. inflammation). At the very least, the confused state of the literature should tell a critically thinking clinician that there is no room for dogma in the nutritional management of renal disease.

Steve

by ericahawker

October 24, 2009

Great question Amy. I often meant to ask this question. Steve thanks for the clear and concise explanation as always!

I feel much more comfortable explaining my rationale behind higher protein diets and renal disease now.

Erica

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