EFEITOS DA CORREÇÃO DA ACIDOSE METABÓLICA COM BICARBONATO DE SÓDIO SOBRE O CATABOLISMO PROTÉICO NA INSUFICIÊNCIA RENAL CRÔNICA
Palavras-chave:
insuficiência renal crônica, catabolismo protéico, acidose, bicarbonato de sódio, desnutrição protéico-energéticaResumo
A desnutrição protéico-energética constitui problema comum aos pacientes com insuficiência renal crônica, influenciando diretamente na sua morbi-mortalidade. A acidose metabólica tem papel no catabolismo protéico, ativando a via proteolítica proteasoma-ubiquitina, dependente de adenosina trifosfato, e conjuntamente com glicocorticóides induz uma maior atividade na desidrogenase que degrada os aminoácidos de cadeia ramificada. Esta revisão teve como objetivo descrever o mecanismo pelo qual a acidose metabólica nos pacientes com insuficiência renal crônica promove o catabolismo protéico, favorecendo assim a desnutrição, bem como avaliar os efeitos do uso de bicarbonato de sódio na correção da acidose e conseqüentemente redução do catabolismo protéico. Pesquisas mostram melhora da acidose pelo uso de bicarbonato de sódio e conseqüente redução do catabolismo protéico na insuficiência renal crônica, podendo ser esta uma conduta promissora na atenuação da desnutrição nestes pacientes.
Referências
AHMED, K.R., KOPPLE, J.D. Nutrition in maintenance hemodialysis patients. In: KOPPLE, J.D., MASSRY, S.G. Nutritional management of renal disease. Baltimore : Williams & Wilkins, 1997. p.588-589.
ATTAIX, D., TAILLANDIER, D., TEMPARIS, S., LARBAUD, D., AUROUSSEAU, E., COMBARET, L., VOISIN, L. Regulation of ATP-ubiquitin-dependent proteolysis in muscle wasting. Reproduction, Nutrition, Development, Paris, v.34, n.6, p.583-597, 1994.
BAILEY, J.L. Metabolic acidosis and protein catabolism mechanisms and clinical implications. Mineral Electrolyte Metabolism, Basel, v.24, n.1, p.13-19, 1998.
BAILEY, J.L., MITCH, W.E. Metabolic acidosis as a uremic toxin. Seminars of Nephrology, New York, v.16, n.3, p.160-166, 1996.
BAILEY, J.L., ENGLAND, B.K., LONG, R.C., MITCH, W.E. Influence of acid loading, extracellular pH and uremia on intracellular pH in muscle. Mineral Eletrolyte Metabolism, Basel, v.22, n.1-3, p.66-68, 1996.
BAILEY, J.L., PRICE, S.R., ENGLAND, B.K., JURKOVITZ, C., WANG, X., DING, X., MITCH, W.E. Signals regulating accelerated muscle protein catabolism in uremia. Mineral Electrolyte Metabolism, Basel, v.23, n.3-6, p.198-200, 1997.
BERGSTROM, J., ALVESTRAND, A., FURST, P. Plasma and muscle-free amino acids in maintenance hemodialysis patients without protein malnutrition. Kidney International, New York, v.38, n.1, p.108-116, 1990.
BIOLO, G., TOIGO, G., CIOCCHI, B., MORENA, G., SITULIN, R., ASILE, A., CARRARO, M., FACCINI, L., GUARNIERI, G. Relationship between whole-body protein turnover and serum creatinine in chronically uremic patients. Mineral Electrolyte Metabolism, Basel, v.24, n.4, p.267-272, 1998.
CARR, S.J., LAYWARD, E., BEVINGTON, A., HATTERSLEY, J., WALLS, J. Plasma amino acid profile in the elderly with increasing uraemia. Nephron, Basel, v.66, n.2, p.228-320, 1994.
CUPISTI, A., BARKER, F., BROWN, J., LOCK, C., BEVINGTON, A., HARRIS, K.P.G., WALLS, J. Effects of acid loading on serum amino acid profiles and muscle composition in normal fed rats. Clinical Science, Colchester, v.85, n.4, p.445-449, 1993.
CUPISTI, A., BAKER, F., BEVINGTON, A., BROWN, J., LOCK, C., HARRIS, K.P.G., WALLS, J. Amino acid profiles and muscle protein composition in rats with a reduced renal mass in the fed state. Nephron, Basel, v.72, n.1, p.183-188, 1996.
ENGLAND, B.K., GREWAL, M., BAILEY, J.L., PRICE, S.R. Acidosis and glicocorticoids induce branched-chain amino acid catabolism. Mineral Eletrolyte Metabolism, Basel, v.22, n.1-3, p.69-71, 1996.
ENGLAND, B.K., GREIBER, S., MITCH, W.E., BOWERS, B.A., HERRING, W.J., McKEAN, M., EBB, R.G., PRICE, S.R., DANNER, D.J. Rat muscle branched-chain ketoacid dehydrogenase activity and mRNA increase with extracelular acidemia. American Journal of Physiology, Bethesda, v. 268, n.6, p.1395-1400, 1995.
ENGLAND, B.K., PRICE, S.R. Acidosis and glucocorticoids interact to provoke muscle protein and amino acid catabolism. Blood Purification, Basel, v.13, n.3-4, p.147-152, 1995.
GARIBOTTO, G., RUSSO, R., SOFIA, A., SALA, M.R., ROBAUDO, C., MOSCATELLI, P., DEFERRARI, G., TIZIANELLO, A. Muscle protein turnover in chronic renal failure patients with metabolic acidosis or normal aci-basic balance. Mineral Eletrolyte Metabolism, Basel, v.22, n.1-3, p.58-61, 1996.
GARIBOTTO, G., RUSSO, R., SALA, M.R., ANCARANI, P., ROBAUDO, C., SOFIA, A., DEFERRARI, G., TIZIANELLO, A. Muscle protein turnover and amino acid metabolism in patients with chronic renal failure. Mineral Eletrolyte Metabolism, Basel, v.18, n.2-5, p.217-221, 1992.
GARIBOTTO, G. Muscle amino acid metabolism and the control of muscle protein turnover in patients with chronic renal failure. Nutrition, v.15, n.2, p.145-155, 1999.
GREIBER, S., MITCH, W.E. Mechanism for protein catabolism in uremia:.metabolic acidosis and activation of proteolytic pathways. Mineral Eletrolyte Metabolism, Basel, v.18, n.2-5, p.233-236, 1992.
JÚNIOR ROMÃO, J.E. Insuficiência Renal crônica. In: CRUZ, J., PRAXEDES, N., CRUZ, H.M.M. Nefrologia. São Paulo : Sarvier, 1994. p.187-200.
LAVILLE, M., FOUQUE, D. Muscular function in Chronic Renal Failure. Advances in Nephology, Chicago, v.24, p.245-263, 1995.
LIM, U.S., YARASHESKI, K.E., FLANIGAN, M.J. The effect of uraemia, acidosis, and dialysis treatment on protein metabolism a longitudinal leucina kinetic study. Nephrology Dialysis Transplant, Berlin, v.13, n.7, p.1723-1730, 1998.
MAY, R.C, MASUD, T., LOGUE, B., BAILEY, J.L., ENGLAND, B.K. Metabolic acidosis accelerates whole body protein degradation and Leucin oxidation by a glucocorticoid-dependent mechanism. Mineral Electrolyte Metabolism, Basel, v.18, n.2-5, p.245-249, 1992.
MITCH, W.E., PRICE, S.R., MAY, R.C., JURKOVITZ, M.D., ENGLAND, M.D. Metabolic consequences of uremia: extending the concept of adaptative responses to protein metabolism. American Journal Kidney Disease, New York, v.23, n.2, p.224-228, 1994.
MITCH, W.E. Metabolic acidosis stimulates protein metabolism in uremia. Mineral Electrolyte Metabolism, Basel, v.22, n.1-3, p.62-65, 1996.
MITCH, W.E., GOLDBERG, A.L. Mechanisms of muscle wasting. New England Journal of Medicine, Boston, v.335, n.25, p.1897-1905, 1996.
MITCH, W.E. Mechanism causing loss of lean body mass in kidney disease. American Journal of Clinical Nutrition, Bethesda, v.67, n.3, p.359-366, 1998.
NARINS, R.G., KRISHINA, G.G., BRESSLER, L. The metabolic acidosis. In: MAXWELL, M.H., KLEEMAN, C.R., NARINS, R.G. Clinical disorders of fluid and electrolyte metabolism. 4.ed. New York : McGraw-Hill, 1987. p.1070-1073.
NEWBY, F.D., PRICE, S.R. Determinants of protein turnover in health and disease. Mineral Electrolyte Metabolism, Basel, v.24, n.1, p.6-12, 1998.
PAPADOYANNAKIS, N.J., STEFANIDIS, C.J., McGEOWN, M. The effect of the correction of metabolic acidosis on nitrogen and potassium balance of patients with chronic renal failure. American Journal of Clinical Nutrition, Bethesda, v.40, n.3, p.623-627, 1984.
PRICE, S.R, BAILEY, J.L., ENGLAND, B.K. Necessary but not sufficient: the role of glucocorticoids in the acidosis-induced increase in levels of mRNA encoding proteins of the ATP-dependent proteolytic pathway in rat muscle. Mineral Electrolyte Metabolism, Basel, v.22, n.1-3, p.72-75, 1996.
REAICH, D., CHANNON, S.M., SCRIMGEOUR, C.M., DALEY, S.E., WILKINSON, R., GOODSHIP, T.H.J. Correction of acidosis in humans with CRF decreases protein degradation and amino acid oxidation. American Journal of Physiology, Bethesda, v.265, n.2, p.230-235, 1993.
WILLIAMS, B., HATTERSLEY, J., LAYWARD, E., WALLS, J. Metabolic acidosis and skeletal muscle adaptation to low protein diets in chronic uremia. Kidney International, New York, v.40, n.4, p.779-786, 1991.
WING, S.S., BANVILLE, D. 14-kDa ubiquitin-conjuating enzime: structure of the rat gene and regulation upon fasting and insulin. American Journal of Physiology, Bethesda, v. 267 (1 pt 1), p.E39-49, 1994.
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