Prevention of Prednisone-lnduced Negative Nitrogen Balance

Abstract

To assess whether increasing dietary protein and calorie intake can ameliorate the negative nitrogen balance induced by 70 to 120 mg/d prednisone, we studied nitrogen intake and net urea generation rate in patients undergoing hemodialysis for 10 to 14 days after renal transplantation. Seven patients receiving prednisone with moderately restricted protein (0.73±0.03 g/kg of body weight per day) and calorie (20±4 kcal/kg of body weight per day) intake had high urea nitrogen generation rates (199±18 mg/kg • d) and protein catabolic rates (1.45±0.12 g/kg • d) and were in marked negative protein balance (-0.72±0.12 g/kg ± d). An increase in protein (1.30±0.06 g/kg • d) and calorie (33±3 kcal/kg • d) consumption in another eight prednisone-treated patients resulted in protein balance (-0.02±0.12 g/kg • d) without further increasing urea generation (174±9 mg/kg • d). Six control patients undergoing hemodialysis after surgery who were not receiving prednisone had lower urea generation rates (109±15 mg/kg • d) and were in nitrogen balance. Nitrogen wasting is therefore not an inevitable consequence of high-dose glucocorticoid therapy and can be effectively prevented by simple nutritional modification without increasing hemodialytic requirements.