臨牀透析 Vol.15 No.13(1)


特集名 腎疾患の栄養とその実際
題名 総括:腎疾患の食事療法の変遷
発刊年月 1999年 12月
著者 越川 昭三 昭和大学藤が丘病院内科
【 要旨 】 腎不全患者の食事療法は前世紀から蛋白制限が基本とされていたが,熱量と必須アミノ酸に十分に配慮された蛋白制限食が可能になったのは1963年以降である.蛋白制限食の目的は1975年までは尿毒症症状軽減であったが,それ以降は腎不全進行阻止がおもな目的となった.1980年代に多くの臨床試験が行われ,有効性は確立されたが,まだ解決すべき多くの問題は残っている.一方,ネフローゼ症候群では,1917年までは蛋白制限,1917年から1985年頃までは高蛋白食,それ以降は軽度蛋白制限という曲折を経て今に至った.蛋白摂取量は糸球体機能や蛋白排泄量と密に関連しており,この問題は今後なお変遷を経る要素をはらんでいる.
Theme Practicing proper nutrition for kidney diseases
Title A history of diet therapy for kidney diseases
Author Syozo Koshikawa Department of Medicine, Showa University, Fujigaoka Hospital
[ Summary ] A low protein diet (LPD) has been used for uremic patients since the last century. However, it was not until1 963 that LPD was fully supplemented with essential amino-acids and caloric needs were first considered. While LPD was used to relieve symptoms of uremia until 1975, it was used to slow therate of progression of renal failure after that. For nephrotic syndrome, LPD has been used before 1917, when Epstein broke with tradition and introduced a high-protein diet (HPD). In 1986, the harmful effects of HPD on glomerular function were revealed, and LPD was revived with as light degree of protein restriction. Since protein intake has a great deal of effect on renal function, many problems relating to protein intake still remain to be solved.
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