THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 543.1 Guest: Dr. Mackenzie Walser, Prof. Of Pharmacology, Molecular Science and Medicine, Johns Hopkins Medical School Topic: Low protein diet for Nephrotic Kidney Syndrome Producer/Host: Steve Girard

NEMA: Researchers at Johns Hopkins have found a seemingly backward way of treating a certain kidney disease...we're with Dr. Mackenzie Walser, a professor of Pharmacology, Molecular Science and Medicine at the Johns Hopkins Medical school, joins us today. Doctor, what is Nephrotic syndrome?

WALSER: Nephrotic syndrome is a severe, chronic kidney condition, characterized by loss of a lot of protein in the urine...usually, urine contains almost no protein. And also, because of this, the serum levels of protein drop way below normal, and as a result of that, the patients usually exhibit massive swelling. In addition to that, they get extraordinary high levels of serum cholesterol...in the 4, 5, 6, 7 hundreds even, sometimes. And this condition usually leads to progressive loss of kidney function, and eventually dialysis or transplantation.

NEMA: What has been the traditional method of treatment for the condition?

WALSER: In the past, the usual treatment has been either high doses of steroids, that is, usually, pregnazone, and/or so called immunosuppressive drugs, that is drugs that affect the immune system, like cyclosporin. Both of these treatments are not always effective, they're more effective in some types of nephrosis than others...they often have rather alarming side effects, so they are not ideal therapy. As far as diet is concerned, in the many years ago, we used a high protein diet to try to make up for the protein losses, but the more protein you eat, the more protein comes out, so more or less low-protein diets were recommended in most cases, but we tried severely restricted diets, more or less as a long shot, based on other work we were doing in patients who did not have Nephrotic syndrome. And to our surprise, they got better.

NEMA: What track were on when you decided to try the very low protein diet on the people with Nephrotic syndrome..?

WALSER: We have been studying very low protein diets with supplements of amino acids, in patients who have kidney disease...without the Nephrotic syndrome...and have shown recently that these diets actually seem to improve protein nutrition, even though they are restricted in protein intake. So we thought we might as well try this in the Nephrotic syndrome as well, even though most people might have thought that was contra-indicated in such patients. I don't know if I mentioned it before, that the people who did seem to get dramatically better, did have these conditions that don't respond normally...or spontaneously get better. So that's why we think that it cannot be chance alone.

NEMA: What's the next step for this discovery?

WALSER: The next step is to try to get support to get a larger study and find out the mechanism, rather than studying how often it happens...and I'm sure it's not going to happen in every case. We'd like to find out why it happens....what is the component of the dietary regimen that we're plying that seems to account for this benefit, or put in another way....what is the component of a normal diet that's preventing these people from getting better, because we've taken something out of their diet that apparently was making them worse.

NEMA: Researchers have to follow every lead, even when it does seem kind of...backward. Thanks to Dr. Mackenzie Walser, a professor at Johns Hopkins Medical School. I'm Steve Girard.