1615 THE RENAL FUNCTIONAL RESPONSE TO AN ACUTE ORAL PROTEIN LOAD (OPL) IN CHILDREN

Abstract

GFR is variable. It is effected by dietary protein. We studied the effect on GFR of an OPL in 6 controls and in 14 patients with various nephropathies. After oral hydration, urine and blood samples were obtained for a baseline creat clearance. Subjects then received an acute OPL of 1-1.5 g/kg BW (max. -80g) as cooked red meat. GFRs were determined at 1 hour intervals post meal. Teat GFR was taken as the max. post meal GFR, typically at 2 hours,

The test GFR defines the filtration capacity(FC). Although normal baseline GFR is similar to that reported in normal adults (123±13), the test GFR is greater (adults - 157±13), indicating a greater renal functional reserve (RFR:test GFR-baseline GFR) in children - 81 vs 34 (in adults). F.C., now 14 yrs old, has a FC less than normal children, yet still greater than that of acutely nephrectomized adults (83±4); possibly a measure of compensatory remnant kidney hypertrophy. Despite normal S-Cr and baseline GFR, A.C. has a low FC correlating with parenchymal scarring on IVP. D.F. and F.D. show that with chronic renal failure all available function ia utilized at baseline with no RFR. Serial OPLs in L.C. show slow return of RFR following the insult of AGN.

As the above examples demonstrate, the determination of FC and RFR may be a useful tool in the evaluation of children with renal disease as well as helpful in the understanding of normal functional development and the pathophysiology of renal disease.

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