Prevention of Prednisone-lnduced Negative Nitrogen Balance

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Abstract
To assess whether increasing dietary protein and calorie intake can ameliorate the negative N balance induced by 70-120 mg/day prednisone, N intake and net urea generation rate in patients undergoing hemodialysis for 10-14 days after renal transplantation were studied. 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 N generation rates (199 .+-. 18 mg/kg per day) and protein catabolic rates (1.45 .+-. 0.12 g/kg per day) and were in marked negative protein balance (-0.72 .+-. 0.12 g/kg per day). An increase in protein (1.30 .+-. 0.06 g/kg per day) and calorie (33 .+-. 3 kcal/kg per day) consumption in another 8 prednisone-treated patients resulted in protein balance (-0.02 .+-. 0.12 g/kg per day) without further increasing urea generation (174 .+-. 9 mg/kg per day). Six control patients undergoing hemodialysis after surgery who were not receiving prednisone had lower urea generation rates (109 .+-. 15 mg/kg per day) 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.