Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020639 (hypoproteinemia)
 1,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From a clinical aspect, there are still a number of unsolved problems in patients with end-stage renal disease, for instance intractable malnutrition. The present study was undertaken to establish the therapeutic effect of recombinant human growth hormone (r-hGH) on the nutritional state and clarify the usefulness of the insulin-like growth factor-I (IGF-I) insulin-like growth factor binding protein-1 (IGFBP-1) ratio as nutritional indices for prediction of the clinical response in uremic patients on hemodialysis. Thirty hemodialysis patients (13 females and 17 males, mean age 56.7 +/- 15.2 years) were studied who were suffering from malnutrition and could not be treated by any of the usual nutritional therapies; they were subjected to 0.5 IU/kg/week of r-hGH subcutaneously after hemodialysis for 2 weeks. Blood samples were collected for measurement of the following plasma biochemical and hematological indices: serum IGF-I, IGFBP-1, growth hormone, total protein (TP), prealbumin, transferrin, albumin, serum urea nitrogen (SUN), creatinine, hematocrit, and amino acids. Immediately after r-hGH administration, SUN, essential amino acid and nonessential amino acid changed from 67.7 +/- 12.3 to 56.5 +/- 10.5 mg/dl (p < 0.05), from 798 +/- 84 to 1,115 +/- 208 microM/l (p < 0.05 vs. baseline), and from 2,185 +/- 221 to 2,814 +/- 621 microM/l (p < 0.05), respectively. Serum IGF-I increased markedly from 193 +/- 49 to 321 +/- 81 ng/ml, whereas serum IGFBP-1 decreased from 139 +/- 13 to 81 +/- 19 micrograms/l (p < 0.05). Four weeks after r-hGH administration, serum TP and albumin increased from 5.5 +/- 0.2 to 6.0 +/- 0.3 g/dl (p < 0.05) and from 3.2 +/- 0.2 to 3.6 +/- 0.3 g/dl (p < 0.05), respectively. Serum IGF-I/IGFBP-1 ratio was significantly higher in patients with an increase of 0.5 g/dl or more in serum albumin than in other patients with poor response and the control group before r-hGH administration. Patients with marked improvement in serum albumin showed an IGF-I/IGFBP-1 ratio of 2 or less. On the other hand, patients without favorable improvement in serum albumin had a higher ratio of 4 or more. We conclude that r-hGH and IGF-I improve the malnutritional state by alleviating hypoproteinemia and abnormality of serum amino acid profile in uremic patients on hemodialysis. In addition, the serum IGF-I/IGFBP-1 ratio is useful not only as a nutritional parameter but also as a predicting index of responsiveness to r-hGH.
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PMID:IGF-I/IGFBP-1 as an index for discrimination between responder and nonresponder to recombinant human growth hormone in malnourished uremic patients on hemodialysis. 938 Feb 35

The prognosis of patients with end-stage renal disease has been improved by the recent remarkable advances in medical and engineering technology. However, there are still many unsolved problems in the clinical field. One of the problems is an intractable malnutrition characterized by clinical manifestations including hypoproteinemia and decrease in muscular volume, which is associated with deterioration in the quality of the patient's life. Malnutrition in hemodialysis patients involves abnormal energy metabolism and aberrant amino acid metabolism. In the most malnourished patients, immunodefense mechanisms and homeostasis are disrupted, greatly influencing the prognosis. Moreover, when the performance of dialyzer used is too high, the dialysis treatment might remove a necessary nutrient for the patient. There is also a possibility that the protein catabolism is accelerated when the biocompatibility is inferior. On the other hand, in malnutri-tion, the circulating level of insulin-like growth factor-1 (IGF-1) falls while the level of insulin-like growth factor binding protein-1 (IGFBP-1) is remarkably increased. It has been recognized that IGF-1 and IGFBP-1 are indicators reflecting the initiation of a malnutritional state in patients with chronic renal failure, although there are many indicators such as albumin, prealbumin, and anthropometric measurement for nutritional assessment. We have suggested that r-hGH and IGF-1 improve the malnutritional state by alleviating hypoproteinemia and abnormality of serum amino acid profile in uremic patients on hemodialysis. The serum IGF-1/IGFBP-1 ratio is useful not only as a nutritional parameter but also as a predicting index of responsiveness to r-hGH. It is necessary to examine the problem from various angles to improve malnutrition in the dialysis patient, while considering the above mentioned.
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PMID:Nutritional effect of dialysis therapy. 1266 6