Christina Okello1, REBECCA LING1, RAJESH RAJ1
1Department of Nephrology, Launceston General Hospital, Launceston, Australia
Background
Deleterious effects of a high protein intake in chronic kidney disease (CKD) are well known, as are the acute increases in creatinine in those without kidney disease who consume certain protein supplements, especially those containing creatine esters. We report a patient with stable CKD stage 3 who presented with an acute kidney decline after taking large amounts of protein supplements.
Case report
A 55-year-old male diabetic and hypertensive patient with a horseshoe kidney, not previously known to the renal service, presented with an unexplained abrupt rise in creatinine from his baseline of 130 to 176 umol/L. In the month prior to attempting to lose weight, he had started a high protein supplement four times daily (an additional 112g of whey and milk protein) along with a predominantly meat-based diet. He had no recent medication changes or known nephrotoxic insults. Urine was unremarkable. A glomerulonephritis screen was negative. Renal ultrasound revealed a horseshoe kidney with no other pathology. His new protein supplements were ceased. This resulted in an immediate, sustained reduction of creatinine to baseline levels. He was advised to continue a low-protein diet, and kidney function remained stable 4 months afterwards.
Conclusion
Our patient had a rise in creatinine temporally associated with a significant increase in protein intake, even though this was mainly whey protein, which has negligible creatine. A high protein diet is known to cause acute haemodynamic changes. This change was poorly tolerated in our patient with pre-existing CKD. The rapid recovery to baseline after withdrawal of supplements supports this hypothesis. This case illustrates the risk of acute renal worsening with even short-term high protein diets in those with chronic kidney disease.
Biography:
Christina Okello is a Basic Physician Trainee at the Launceston General Hospital.She received her medical degree at the University of Nairobi, Kenya.Her most recent publications include ” A complex case of emphysematous cystitis in a peritoneal dialysis patient”(July 2021) and ‘An adverse drug reaction with a combination of Oxaliplatin and Perindopril’ (2021). Her current research interests include improving access to renal care in resource limited settings.