Morbid obesity in a young woman affected by advanced chronic kidney disease: an exceptional case report. Does a high dose of essential amino acids play a key role in therapeutic success?Open

摘要

A 38-year-old woman, obese (219?kg), diabetic, hypertensive, chronic kidney disease (CKD) stage 4, with low plasma albumin level (2.9?g?dl?1) and marked proteinuria (22?g per day) was studied. Given the advanced-stage CKD with nephrotic proteinuria, we supplemented low-protein diet with high doses of a tailored essential amino acid mixture (AAs: 44?g per day) to improve weight reduction in the patient. After 20 months of conservative therapy, the patient lost 43?kg; despite two episodes of infection, albumin plasma levels increased up to 3.7?g per day. After a further 20 months of dialysis, the patient maintained a diet of 1800 kcal supplemented with 32?g of AAs and lost 47?kg, whereas both albumin (3.89±0.12?g?dl?1) and C reactive protein returned to normal. During the follow-up period, anemia improved, erythropoietin was thus discontinued and insulin requirement decreased to 105 IU. This therapeutic option may be beneficial in advanced CKD patients with obesity and diabetes resulting from malnutrition.