Proteins

Proteins in the Diet

Proteins are made of amino-acids, which join together to form peptides, poly-peptides and finally proteins.

These take part in the maintenance of biological functions, growth and death of the body. These are essential parts of the diet and are 2nd most common molecules after water in the body.

The nine essential amino-acids not produced in the body are  phenylalaninevalinethreoninetryptophanmethionineleucineisoleucinelysine, and histidine.

The dietary requirements for proteins are about 1 gm/kg/day in adults. Children and pregnant and lactating mothers require additional amounts.

Higher quantities of protein increase acid content in the body. To compensate for this kidneys have to excrete higher amounts in the urine. Calcium excretion also increases. This may result in a tendency towards stone formation. Acidosis may result in osteoporosis.

Protein lack in the diet is a part of protein-energy malnutrition. This can result in growth retardation in children, increased incidence of infections, debility and if severe death. Low albumin levels in the body make a person more susceptible to cardiovascular and cerebrovascular accidents.

Protein deficiency can result from a poor intake, poor absorption from the intestines, increased losses from urine, skin (burns etc.), gastrointestinal tract, or increased destruction as in severe infections. Metabolism of proteins may be disturbed in genetic disorders and liver ailments also.

Metabolic Syndrome

(Syndrome X, MetS, Insulin Resistance Syndrome)

It is being increasingly identified in the urban population. The importance lies in its association with risk of developing diabetes mellitus and cardiovascular disease. The incidence in South Asian Population during middle age groups is estimated at 30 to 40%.

The criteria for diagnosis (ATPIII) are

  1. Waist circumference >40 inches in man and > 35 inches in woman
  2. Fasting blood glucose >100 mg/dl or treatment for high sugars
  3. BP of >130/85 mm Hg or drug treatment for hypertension
  4. S Triglycerides >150 mg/dl or drug treatment for elevated triglycerides
  5. HDL cholesterol <40 mg/dl in man or <50 mg/dl in woman

Any 3 of these 5 criteria qualify for a diagnosis of metabolic syndrome. In some modifications, waist circumference has been made an essential criterion while in some waist circumference has been modified for different ethnic groups. In South Asians now the waist circumference has been reduced to 90 and 80 cms respectively for man and woman.

The factors associated with high risk for metabolic syndrome are

age, race, weight, postmenopausal status, smoking, lack of physical activity, alcohol intake, household income etc.

The syndrome gains importance as it has been found to

  • Increase risk of diabetes mellitus by 5 to 5 times
  • Risk of Cardiovascular ailments by 5 to 2 times.

It is also associated with increased risk for

  • Chronic kidney disease
  • Fatty liver,(steatosis), fibrosis and cirrhosis of liver
  • Cholangiocarcinoma and hepatocellular carcinoma
  • Obstructive sleep apnea
  • Polycystic ovary syndrome
  • Hyperuricemia and Gout.

Treatment requires multimodality approach with modifications of diet, physical activity, cessation of smoking, and drugs as needed. Aggressive treatment reduces the risk of diseases associated with syndrome X and is thus rewarding.

Urinary Tract Infection: Men

UTI in Men

Compared to women, Urinary tract infections in men are uncommon. This is due to the longer length of urethra and dryness of the urethral opening (called meatus). Prostatic secretions have antibacterial properties and hence these may prevent urinary tract infections. Non-circumcision is also a risk factor for UTI. The commonest organism is E coli.

UTI is common if there is an anatomic abnormality, obstruction, instrumentation of the urinary tract or prior surgery. In men after 50 years of age, prostatic enlargement can make a person prone to UTI.

As in the case of women, the infections of the urinary tract may involve urethra, bladder or kidney or a combination of all of them. In addition, the prostate gland can also be infected.

Symptoms :

Symptoms are similar to those in women. However, infections of the prostate can give rise to fever and pain in the perineum (the area between anus and scrotum).

Diagnosis of UTI is by its symptoms, physical examination and laboratory tests. The prostate is tender on digital examination of the rectum.

Urine shows increased pus cells, nitrate test is positive and midstream urine culture shows >105 bacteria /ml of urine. In case of recurrence, if no cause is apparent, tests are done to ascertain anatomical details of the urinary tract.

Treatment is started empirically. In case of no or poor response in 2-3 days, the drugs are modified based on culture results.

Urinary Tract Infections : Women

UTI in short, is a common illness in woman, especially during the reproductive period. The incidence in western countries is .5/woman /year.

It is commoner in women compared to men due to their shorter urethra (Tube from the lower end of the bladder to opening for urine). Bacteria from large intestines contaminate the skin around the anus, migrate to the vaginal opening and may ascend through the urethra to the bladder and sometimes via ureter to the kidneys.

Infections of the bladder are called cystitis, infections of urethra  urethritis and that of kidneys pyelonephritis.

Symptoms of UTI

In cases of urethritis, pain while passing urine (dysuria), more frequency, pus discharge from urine opening may occur.

In cases of cystitis, dysuria, frequency, urgency (inability to hold urine), lower abdominal pain or discomfort and sometimes blood in urine may occur.

In pyelonephritis the symptoms usually are : fever (temp above 38° C ), flank pain or discomfort, tenderness on touching at the angle of lower ribs with muscles( costovertebral angle) in addition to dysuria frequency etc. Nauusea and vomitings are also common. This can be a serious illness with fall of BP, shock and malfunction of other organs in the body.

Risk Factors In Women

Risk factors for UTI in a woman are previous UTI’s, abnormal anatomy, stones or other obstructions, sexual intercourse and use of spermicidal jellies. Women in some countries may not complain due to social taboos.

Diagnosis is based on history and finding of pus cells and bacteria in midstream urine. It can be confirmed by urine culture. Collection of proper midstream sample after proper cleaning and drying of genital areas is important to avoid false results.

Treament consists of short course of antibiotics in uncomplicated cases. Complicated cases may require hospitalisation and injectable antibiotics. Antibiotic selection depends on the usual causative agents in the area. Treatment of repeated UTI is different. In urethritis the organisms are often different and require other chemotherapeutic agents.

MYTHS AND FACTS ABOUT KIDNEY DISEASE

Myth : All kidney diseases are serious and incurable

Fact : Most kidney diseases are treatable. Some are self-limiting and occur only once in a lifetime. Some progress towards renal failure but this progression can be slowed down if the disease is detected early. Even in late cases, treatment may help in reversing or slowing down the loss of kidney function.

Myth : only one kidney is affected by kidney diseases.

Fact : All medical diseases (high BP, diabetes, glomerulonephritis, nephrotic syndrome, poisonings, infections of urinary tract etc) affect both kidneys.

Some structural diseases like tumours, stones, abscesses, renal artery or vein clots, ureteral narrowings, may affect only one kidney.

Myth : I am passing enough urine. Hence my kidneys are not obstructed.

Facts : Most obstructions of the bladder and partial obstructions of the ureter  (stones or accidental ligation during surgery) cause more urine to be formed and passed. Only bilateral total obstruction or obstruction below bladder neck cause reduced urine output.

Myth : I am passing enough urine. Hence my kidneys are healthy and I do not require treatment or dialysis.

Fact : Some kidney disease cause decreased urine output or oliguria (< 400 ml urine/day). Most, however, are nonoliguric or Polyuric (urine output > 3000 ml/day). Even with normal or large urine production, waste material like acids, potassium, urea, creatinine and many more may not be excreted. A person then may require treatment at times dialysis as well.

Myth : Drinking more water will keep my kidneys healthy. This is the treatment for kidney diseases.

Fact : Usual water intake is well managed by thirst in healthy people. Drinking 2-3 litres of fluid may avoid some stone formations and urinary tract infections. Continuing to drink fluids when kidneys are failing or have failed may cause fluid in the lungs (pulmonary edema) or poor control of hypertension. The consequences may be deadly. Follow your doctors’ advice.

Myth : Dialysis once started is required life long.

Fact : In temporary or reversible renal failure, dialysis is required till kidney recovers. In CKD or ESRD with no reversibility, dialysis is required for emergency treatment of high potassium or fluid in the lungs. Maintainance dialysis for uremic symptoms, neuropathy, encephalopathy, pericarditis etc usually means either lifelong dialysis or renal transplant.