S. Bozfakoglu
Division of Nephrology, Department of Internal Medicine, Medical School of Istanbul, University of Istanbul,
Istanbul, Turkey
The hallmark of metabolic changes in ARF is protein In patients with ARF, triglyceride content of plasma
catabolism and negative nitrogen balance. The causes lipoproteins is elevated. Total cholesterol and in
of hypercatabolism are complex and manifold. The particular high-density lipoprotein cholesterol levels
major stimulus of protein catabolism in ARF is are decreased whereas low-density lipoprotein choles-
insulin resistance. The maximal insulin-stimulated pro- terol and very-low-density lipoprotein cholesterol are
tein synthesis is decreased and protein degradation is increased. The main cause of these abnormalities is the
increased. As a result, excessive release of amino acids impairment of lipolysis w4,5x.
from muscle occurs, and gluconeogenesis and urea-
genesis are increased due to hepatic uptake of these
amino acids from the circulation. On the other hand, Energy metabolism
synthesis of some amino acids in the kidney is
impaired, while catabolism of peptide hormones is
Energy expenditure remains unchanged and near-
normal in uncomplicated ARF such as monofactorial
ARF. In contrast, oxygen consumption and resting
Correspondence and offprint requests to: Semra Bozfakog lu,
University of Istanbul, Medical School of Istanbul, Department of energy expenditure increases by 30% and even
Internal Medicine, Division of Nephrology, 34390 Capa-Istanbul, more when sepsis or systemic inflammatory response
Turkey. syndrome is associated with ARF w2x.