renal failure n amino acids (tribute to Dr Raj shankar who is no more)

Rajshankar Tony Sarma

Further to discussion we had about use of amino acids in renal and hepatic cases, just got a reply from the only person known to be double boarded in nutrition...

Like · · Follow Post · October 23, 2010 at 11:19am

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  Rajshankar Tony Sarma In liver failure, if there is no hepatic encephalopathy ( HE), the protein content does not need to be decreased.
  
  Where HE is a problem, it appears the type of protein and amino acids does make a difference. Either soy or dairyprotein ( e.g. cottage cheese) contains a higher branched chain to aromaticamino acid ratio, and causes much less HE. I've also tried quorn on a dog recently, but only because he won't eat anything else, not from evidence based information about fungal proteins!
  
  While supplementing branched chain amino acids in liver disease is tempting,the studies that have been done (I think only in people) have not shown a benefit...maybe we need more dog and cat studies.
  
  For chronic kidney disease, we know that decreasing phosphorus is associated with longer survival, but as protein can't be separated from phosphorus in the diet we actually don't know the effect of protein. Decreasing protein will decrease urea, but it probably isn't a toxin and probably doesn't affect how they are feeling and appetite. Especially in cats, I only use moderate protein restriction for CKD. I don't think anyone has looked at particular amino acids in CKD. In short, no evidence I know of to supplement amino acids over protein. About the only time we do this, other than parenteral nutrition, is for some protein losing nephropathies.
  
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  I'd also add that this also suggests that adding amino acids to a diet already containing protein and therefore increasing phosphorus load in renals may be a bad thing.

  October 23, 2010 at 11:19am · Unlike · 2
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  Premal Darji i was giving AA to my dog with jaundice and ARF regularly till he astrted eating..and wasnt harmfull..i dont knw did it help or not...but wasnt surly harmfull..also lots of other supposrtive treatments were going on ..

  October 23, 2010 at 1:46pm · Like
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  Singh AD yes premal we to use it regularly without any added side effects

  October 23, 2010 at 3:18pm · Like
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  Prerna Vaswani-Thadani @dr raj: thanks :)

  October 23, 2010 at 3:49pm · Like
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  Rajshankar Tony Sarma Sounds to me like use has historically been advocated on relatively loose theory - which medical practitioners (vets and doctors) often do with difficult diseases which we have limited treatment options for. The temptation is to try things because there *must* be something we can do, and nothing else works, so hey, let's try... Not in itself wrong, but it means we certainly medicate without proven benefits.
  
  This can later be a problem if the treatment is proven not to work or even to work badly - think about roles of anti-testosterone therapies in prostatic carcinomas - now known to be contraindicated, but for years were given regularly, and whilst the contraindication was in my college notes 12 years ago, I still see cases being managed that way now.
  
  Going back to amino acids in the hepatorenal scenarios... Risks are potential rather than reported; however, I would have to suggest that if using these therapeutically, the owner should be advised of what we can reasonably expect from amino acid therapy.
  
  From a "theoretical benefit" perspective, this strikes me as a similar scenario to GAGs in feline cystitis: "may help but nothing proven".
  
  The worrying differences are:
  
  1) At least with GAGs there is some evidence of mild anti-inflammatory action, which may be useful as an analgesic;
  
  2) Moreover, unlike GAGs in cystitis, for amino acids I could extremely easily also back up - with some convincing scientific theory, as agreed by that other medic I contacted on this - the statement "may cause severe problems, but nothing proven".

  October 23, 2010 at 4:22pm · Unlike · 4
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