Despite lack of any quantitative fluid and dietary data, it is widely claimed that patients with oliguric acute renal failure (ARF) are in a catabolic state because they receive inadequate calories, given the fluid constraints imposed by therapy of this condition. We studied this problem by carefully analyzing fluid and calorie balance in 10 consecutive infants with ARF (urine output <20 cc/kg/day) secondary to major surgical procedures. Each patient received parenteral hyperalimentation from the onset of oliguria. A specially constructed fluid balance sheet was used to aid in the fluid calculation, and the caloric content of wound and chest tube drainage was estimated by analysis of protein content. The caloric value of blood given or lost, and of various protein infusates was also estimated. Serum and urinary albumin, transferrin, and IgG levels were serially measured during the first 3 days of oliguria.
The mean net volume of fluid received was 45 ± 14 cc/kg/day. The mean weight gain during the period of oliguria (median time 7 days) was 13% above preoperative weight. There was a large variation in the net number of calories received with the mean value being 34 ± 17 cal/kg/day. Significant reductions in serum levels of albumin occurred in 7, transferrin in 6, and IgG in 2 patients despite minimal absolute urinary protein loss.
These data suggest that a catabolic state is present in ARF that can be largely explained by inadequate calorie intake.
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Ellis, D., Knappenberger, W. FLUID AND CALORIC INTAKE IN INFANTS WITH ACUTE RENAL FAILURE. Pediatr Res 14, 1016 (1980) doi:10.1203/00006450-198008000-00260