Lowprotein Diet: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

LOW-PROTEIN DIET A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Low-Protein Diet: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00681-2 1. Low-Protein Diet-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on low-protein diet. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON LOW-PROTEIN DIET .................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Low-Protein Diet .......................................................................... 5 E-Journals: PubMed Central ......................................................................................................... 6 The National Library of Medicine: PubMed .................................................................................. 6 CHAPTER 2. NUTRITION AND LOW-PROTEIN DIET ........................................................................ 19 Overview...................................................................................................................................... 19 Finding Nutrition Studies on Low-Protein Diet ......................................................................... 19 Federal Resources on Nutrition ................................................................................................... 20 Additional Web Resources ........................................................................................................... 21 CHAPTER 3. ALTERNATIVE MEDICINE AND LOW-PROTEIN DIET.................................................. 23 Overview...................................................................................................................................... 23 National Center for Complementary and Alternative Medicine.................................................. 23 Additional Web Resources ........................................................................................................... 28 General References ....................................................................................................................... 29 CHAPTER 4. BOOKS ON LOW-PROTEIN DIET .................................................................................. 31 Overview...................................................................................................................................... 31 Book Summaries: Federal Agencies.............................................................................................. 31 Chapters on Low-Protein Diet ..................................................................................................... 32 CHAPTER 5. PERIODICALS AND NEWS ON LOW-PROTEIN DIET .................................................... 35 Overview...................................................................................................................................... 35 News Services and Press Releases................................................................................................ 35 Newsletter Articles ...................................................................................................................... 36 Academic Periodicals covering Low-Protein Diet........................................................................ 37 CHAPTER 6. RESEARCHING MEDICATIONS .................................................................................... 39 Overview...................................................................................................................................... 39 U.S. Pharmacopeia....................................................................................................................... 39 Commercial Databases ................................................................................................................. 40 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 43 Overview...................................................................................................................................... 43 NIH Guidelines............................................................................................................................ 43 NIH Databases............................................................................................................................. 45 Other Commercial Databases....................................................................................................... 47 APPENDIX B. PATIENT RESOURCES ................................................................................................. 49 Overview...................................................................................................................................... 49 Patient Guideline Sources............................................................................................................ 49 Finding Associations.................................................................................................................... 52 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 55 Overview...................................................................................................................................... 55 Preparation................................................................................................................................... 55 Finding a Local Medical Library.................................................................................................. 55 Medical Libraries in the U.S. and Canada ................................................................................... 55 ONLINE GLOSSARIES.................................................................................................................. 61 Online Dictionary Directories ..................................................................................................... 61 LOW-PROTEIN DIET DICTIONARY......................................................................................... 63 INDEX ................................................................................................................................................ 85

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with low-protein diet is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about low-protein diet, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to low-protein diet, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on low-protein diet. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to low-protein diet, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on low-protein diet. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON LOW-PROTEIN DIET Overview In this chapter, we will show you how to locate peer-reviewed references and studies on low-protein diet.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and low-protein diet, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “low-protein diet” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Resistance Training to Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency Source: Annals of Internal Medicine. 135(11): 965-976. December 4, 2001. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Chronic renal insufficiency (CRI) leads to muscle wasting, which may be exacerbated by low-protein diets prescribed to delay or slow disease progression. Resistance training increases protein utilization and muscle mass. This article reports on a study undertaken to determine the efficacy of resistance training in improving protein utilization and muscle mass in patients with CRI treated with a low protein diet. Results

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that show that resistance exercise training can preserve lean body mass, nutritional status, and muscle function in patients with moderate chronic kidney disease. The study's results suggest that resistance training is a safe and effective countermeasure to the negative effects of protein restriction on muscle mass accretion, protein utilization, nutritional status, and muscle function in patients with chronic kidney disease. 3 figures. 4 tables. 43 references. •

Low-Protein Diets in Renal Disease Source: Diabetes Care. 14(9): 856-866. September 1991. Summary: End-stage renal disease is a major cause of morbidity and mortality in the U.S. population and a significant contributor to national health-care expenditures. A growing body of literature has accumulated to suggest that dietary protein restriction can significantly retard the progression of chronic renal insufficiency. This article reviews the relevant literature and outlines the questions that remain for future investigation. Topics include the acute alterations in glomerular filtration rate and protein excretion as a result of dietary protein restriction; the effect of dietary protein restriction on the progression of renal disease; and the mechanisms by which protein intake may alter renal function and affect progression of renal disease. 1 figure. 2 tables. 88 references. (AA-M).

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Randomised Multicentre Study of a Low-Protein Diet on the Progression of Chronic Renal Failure in Children Source: Lancet. 349(9059): 1117-1123. April 19, 1997. Contact: Available from Lancet, Ltd. 655 Avenue of the Americas, New York, NY 10010. (212) 633-3800. Fax (212) 633-3850. Summary: Some studies have suggested that a low protein diet slows the deterioration of renal function in patients with chronic renal failure (CRF). This article reports on a 2 year prospective, stratified and randomized multicenter study that included 191 patients aged 2 to 18 years. After a run in period of at least 6 months, patients were stratified into either a progressive or nonprogressive category based on the change in creatinine clearance in this period. The patients were also stratified into three renal disease categories and then randomly assigned to a control or diet group. In the diet group, the protein intake was the lower, safe World Health Organization (WHO) recommendation (0.8 to 1.1 grams per kilogram daily, adjusted for age). All patients were advised to have a calorie intake of at least 70 percent of the WHO recommendations. Glomerular filtration rate (GFR) was measured every 2 months by creatinine clearance; dietary compliance was checked by urinary urea nitrogen excretion and dietary diaries (weighing method). One hundred and twelve (112) patients completed an optional third year of the study. The low protein diet did not affect growth. However, there was no effect of diet on the mean decline in creatinine clearance over 2 years. Patients classified as having progressive disease were older and had a lower creatinine clearance and a higher blood pressure at randomization, and had a greater decrease in creatinine clearance than nonprogressive patients. Proteinuria and systolic blood pressure were independent predictors of the change in GFR. Similar results were found after the study was extended for a third year. The authors conclude that a low protein diet for 3 years did not affect the decrease in renal function in children with CRF. Proteinuria and blood pressure explain a large part of the variability of, and may be causally related to, the decline in the GFR. 3 figures. 5 tables. 29 references.

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Adaptive Response to a Low-Protein Diet in Predialysis Chronic Renal Failure Patients Source: JASN. Journal of the American Society of Nephrology. 12(6): 1249-1254. June 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: This article reports on a randomized, controlled study of 12 patients with mild chronic renal (kidney) failure that was designed to assess the metabolic effects of a low protein diet supplemented (n = 6) or not supplemented (n = 6) with ketoanalogs of amino acids. The protein intake was prescribed so that both groups were isonitrogenous (equal in nitrogen intake). The dietary survey each month included a 3 day food record and a 24 hour urine collection for urea measurement. After a 4 to 6 week equilibrium period (standard diet, 1.11 grams of protein and 32 kcal per kilogram of body weight per day), patients reduced their protein intake to reach 0.71 grams of protein per kilogram per day during the third month. Energy intake was kept constant during the 3 month period. Compliance to the diet was achieved after 2 months of training. Leucine turnover measurement was performed before and at the end of the 3 month low protein period. There was no clinical change, whereas total body flux decreased by 8 percent and leucine oxidation by 18 percent. No difference could be attributed to the ketoanalogs themselves. Thus, the authors conclude that under sufficient energy intake, a low protein diet is nutritionally and metabolically safe during chronic renal failure. The nitrogen sparing effect of a low protein diet is still present during mild chronic renal insufficiency. 1 figure. 4 tables. 29 references.

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Low-Protein Diet for Renal Disease Source: Practical Diabetology. 10(2): 23. March-April 1991. Summary: This brief article reviews the potential benefits of a protein-restricted diet for patients with diabetes in order to prevent or delay the progression of diabetic nephropathy. The author emphasizes the importance of dietary counseling and meal planning education in implementing a successful low-protein diet.

Federally Funded Research on Low-Protein Diet The U.S. Government supports a variety of research studies relating to low-protein diet. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to low-protein diet.

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore low-protein diet.

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “low-protein diet” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for low-protein diet in the PubMed Central database: •

A low-protein diet restricts albumin synthesis in nephrotic rats. by Kaysen GA, Jones H Jr, Martin V, Hutchison FN.; 1989 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=303869

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Placental lactogen administration reverses the effect of low-protein diet on maternal and fetal serum somatomedin levels in the pregnant rat. by Pilistine SJ, Moses AC, Munro HN.; 1984 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=391810

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with low-protein diet, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “low-protein diet” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for low-protein diet (hyperlinks lead to article summaries): 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

Studies

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A low-protein diet improves insulin sensitivity of endogenous glucose production in predialytic uremic patients. Author(s): Rigalleau V, Blanchetier V, Combe C, Guillot C, Deleris G, Aubertin J, Aparicio M, Gin H. Source: The American Journal of Clinical Nutrition. 1997 May; 65(5): 1512-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9129485

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Adaptive response to a low-protein diet in predialysis chronic renal failure patients. Author(s): Bernhard J, Beaufrere B, Laville M, Fouque D. Source: Journal of the American Society of Nephrology : Jasn. 2001 June; 12(6): 1249-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11373349

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Additive antiproteinuric effect of ACE inhibition and a low-protein diet in human renal disease. Author(s): Gansevoort RT, de Zeeuw D, de Jong PE. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1995; 10(4): 497-504. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7623991

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Body composition during long-term treatment of uremia with amino acid supplemented low-protein diet. Author(s): Attman PO, Ewald J, Isaksson B. Source: The American Journal of Clinical Nutrition. 1980 April; 33(4): 801-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7361698

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Chronic renal failure from urological diseases: treatment by sodium balancing and low-protein diet of high biological value. Author(s): McDonald HP Jr, Waterhouse RK. Source: The Journal of Urology. 1970 March; 103(3): 262-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5412735

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Compliance with low-protein diet by uremic patients: three years' experience. Author(s): Aparicio M, Gin H, de Precigout V, Marot D, Winnock S, Morel D, Bouchet JL, Potaux L. Source: Contrib Nephrol. 1990; 81: 71-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2093514

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Controlled trials on low-protein diet: effects on chronic renal insufficiency progression. Author(s): Locatelli F, Marcelli D, Tentori F, Bigi MC, Marai P. Source: Renal Failure. 1993; 15(3): 407-13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8516499

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Does a low-protein diet help with Parkinson's? Author(s): Yen PK. Source: Geriatric Nursing (New York, N.Y.). 1990 January-February; 11(1): 48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2153623

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Early administration of angiotensin-converting enzyme inhibitor captopril, prevents the development of hypertension programmed by intrauterine exposure to a maternal low-protein diet in the rat. Author(s): Sherman RC, Langley-Evans SC. Source: Clinical Science (London, England : 1979). 1998 April; 94(4): 373-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9640343

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Effect of a low-protein diet on chemiluminescence production by leukocytes from uremic patients. Author(s): Aparicio M, Vincendeau P, Gin H, Potaux L, Bouchet JL, Martin-Dupont P, Morel D, de Precigout V, Bezian JH. Source: Nephron. 1988; 48(4): 315-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3362279

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Effect of a low-protein diet on the rate of progression of chronic renal failure in patients with polycystic kidney disease. Author(s): Gretz N, Strauch M. Source: Contrib Nephrol. 1992; 97: 93-100. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1633719

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Effect of a low-protein diet on urinary albumin excretion in uremic patients. Author(s): Aparicio M, Bouchet JL, Gin H, Potaux L, Morel D, de Precigout V, Lifermann F, Gonzalez R. Source: Nephron. 1988; 50(4): 288-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3237270

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Effect of low-fat, low-protein diet on blood viscosity factors. Author(s): Dintenfass L. Source: The Medical Journal of Australia. 1982 June 26; 1(13): 543. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7110004

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Effect of low-protein diet on renal function: are there definite conclusions from adult studies? Author(s): Gretz N, Lasserre JJ, Hocker A, Strauch M. Source: Pediatric Nephrology (Berlin, Germany). 1991 July; 5(4): 492-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1911128

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Effectiveness of modified Giovannetti diet compared with mixed low-protein diet. Author(s): Wright PL, Brereton PJ, Snell DE. Source: Metabolism: Clinical and Experimental. 1970 March; 19(3): 201-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4906364

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Effects of ascorbic acid and low-protein diet in alkaptonuria. Author(s): Mayatepek E, Kallas K, Anninos A, Muller E. Source: European Journal of Pediatrics. 1998 October; 157(10): 867-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9809834

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Effects of low-protein diet on carbohydrate metabolism and energy expenditure. Author(s): Rigalleau V, Aparicio M, Gin H. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 1998 October; 8(4): 175-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9776793

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Effects of low-protein diet supplemented with ketoacids on plasma lipids in adult chronic renal failure. Author(s): Bernard S, Fouque D, Laville M, Zech P. Source: Mineral and Electrolyte Metabolism. 1996; 22(1-3): 143-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8676807

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Effects of oral adsorbent AST-120 concurrent with a low-protein diet on the progression of chronic renal failure. Author(s): Owada A, Shiigai T. Source: American Journal of Nephrology. 1996; 16(2): 124-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8919228

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Elderly women accommodate to a low-protein diet with losses of body cell mass, muscle function, and immune response. Author(s): Castaneda C, Charnley JM, Evans WJ, Crim MC. Source: The American Journal of Clinical Nutrition. 1995 July; 62(1): 30-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7598064

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Energy balance in predialysis patients on a low-protein diet. Author(s): Passey C, Bunker V, Jackson A, Lee H. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2003 April; 13(2): 120-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12671835

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Enhanced metabolic effect of erythropoietin and keto acids in CRF patients on lowprotein diet: Czech multicenter study. Author(s): Teplan V, Schuck O, Knotek A, Hajny J, Horackova M, Kvapil M; Czech multicenter study. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S26-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12612947

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Estimation of insulin sensitivity in uremic patients before and after initiation of a low-protein diet. Author(s): Gin H, Aparicio M, Potaux L, Bouchet JL. Source: Clinical Nephrology. 1988 March; 29(3): 162-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3282733

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Evaluation of essential amino acids and keto acids in uremic patients on low-protein diet. Author(s): Heidland A, Kult J, Rockel A, Heidbreder E. Source: The American Journal of Clinical Nutrition. 1978 October; 31(10): 1784-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=707333

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Factors influencing dietary compliance in patients with chronic renal failure on unsupplemented low-protein diet. Author(s): Oldrizzi L, Rugiu C, De Biase V, Maschio G. Source: Contrib Nephrol. 1990; 81: 9-15. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2093517

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Growth during treatment with low-protein diet in children with renal failure. Author(s): Sigstrom L, Attman PO, Jodal U, Odenman I. Source: Clinical Nephrology. 1984 March; 21(3): 152-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6705278

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Impairment of theophylline clearance by a hypocaloric low-protein diet in chronic obstructive pulmonary disease. Author(s): Juan D, Shin SG, Fisher M, Hughes RL. Source: Therapeutic Drug Monitoring. 1990 January; 12(1): 111-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2305414

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Increase of circulating insulin-like growth factor-I in chronic renal failure is reduced by low-protein diet. Author(s): Fouque D, Joly MO, Laville M, Beaufrere B, Goudable J, Pozet N, Chatelain P, Zech P. Source: Mineral and Electrolyte Metabolism. 1992; 18(2-5): 276-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1465074

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Indoxyl sulfate and progression of renal failure: effects of a low-protein diet and oral sorbent on indoxyl sulfate production in uremic rats and undialyzed uremic patients. Author(s): Niwa T, Tsukushi S, Ise M, Miyazaki T, Tsubakihara Y, Owada A, Shiigai T. Source: Mineral and Electrolyte Metabolism. 1997; 23(3-6): 179-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9387112

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Insulin-like growth factor-1 and its binding proteins during a low-protein diet in chronic renal failure. Author(s): Fouque D, Le Bouc Y, Laville M, Combarnous F, Joly MO, Raton P, Zech P. Source: Journal of the American Society of Nephrology : Jasn. 1995 November; 6(5): 1427-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8589318

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Interventions based on microalbuminuria screening and low-protein diet in the treatment of kidney disease of diabetes mellitus. Author(s): Viberti GC. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1989 January; 13(1): 41-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2643309

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Isocaloric maternal low-protein diet alters IGF-I, IGFBPs, and hepatocyte proliferation in the fetal rat. Author(s): El-Khattabi I, Gregoire F, Remacle C, Reusens B. Source: American Journal of Physiology. Endocrinology and Metabolism. 2003 November; 285(5): E991-E1000. Epub 2003 August 05. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12902319

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L-asparaginase and low-protein diet in acute leukaemia. Author(s): Halikowski B, Garwicz S, Armata J. Source: Lancet. 1969 February 22; 1(7591): 423-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4179272

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Long-term control of hyperparathyroidism in advanced renal failure by lowphosphorus low-protein diet supplemented with calcium (without changes in plasma calcitriol). Author(s): Combe C, Morel D, de Precigout V, Blanchetier V, Bouchet JL, Potaux L, Fournier A, Aparicio M. Source: Nephron. 1995; 70(3): 287-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7477615

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Long-term enalapril therapy in patients with chronic renal failure on a low-protein diet. A prospective randomized comparison with metoprolol. Author(s): Shiigai T, Hattori K, Iwamoto H, Owada A. Source: Nephron. 1998; 79(2): 148-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9647493

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Low-protein diet and glomerular size-selective function in membranous glomerulopathy. Author(s): Remuzzi A, Perticucci E, Battaglia C, D'Amico G, Gentile MG, Remuzzi G. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1991 March; 17(3): 317-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1996576

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Low-protein diet and progression of chronic renal failure. Author(s): Ledermann S, Shaw V, Trompeter R. Source: Lancet. 1997 July 12; 350(9071): 146. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9228990

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Low-protein diet and progression of chronic renal failure. Author(s): Nonoguchi H, Kiyama S, Naruse M, Tomita K. Source: Lancet. 1997 July 12; 350(9071): 146. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9228989

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Low-protein diet and progression of chronic renal failure. Author(s): Locatelli F. Source: Lancet. 1997 July 12; 350(9071): 145-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9228988

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Low-protein diet and progression of diabetic kidney disease. Author(s): Viberti GC. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1988; 3(3): 334-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3140110

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Low-protein diet and progression of renal disease in diabetic nephropathy. Author(s): Viberti GC, Walker J, Dodds R. Source: Lancet. 1990 March 3; 335(8688): 550-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1968567

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Low-protein diet and progression of renal disease: an endless story. Author(s): Maschio G. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1995 October; 10(10): 1797-800. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8592584

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Low-protein diet and psoriasis. A hospital study. Author(s): Zackheim HS, Farber EM. Source: Archives of Dermatology. 1969 May; 99(5): 580-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5780964

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Low-protein diet and renal osteodystrophy. Author(s): Aparicio M, Lafage MH, Combe C, de Precigout V, Bouchet JL, Potaux L. Source: Nephron. 1991; 58(2): 250-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1865990

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Low-protein diet in children with chronic renal failure--1-year results. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. Author(s): Wingen AM, Fabian-Bach C, Mehls O. Source: Pediatric Nephrology (Berlin, Germany). 1991 July; 5(4): 496-500. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1911129

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Low-protein diet supplemented by keto acids in chronic renal failure: a prospective controlled study. Author(s): Gretz N, Korb E, Strauch M. Source: Kidney International. Supplement. 1983 December; 16: S263-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6376916

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Low-protein diet supplemented with essential amino acids and keto analogues. Effects on uremic polyneuropathy and encephalopathy. Author(s): Cappelli P, Di Paolo B, Evangelista M, Di Marco T, Albertazzi A. Source: Contrib Nephrol. 1986; 53: 58-63. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3026730

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Metabolic effects of keto acid--amino acid supplementation in patients with chronic renal insufficiency receiving a low-protein diet and recombinant human erythropoietin--a randomized controlled trial. Author(s): Teplan V, Schuck O, Votruba M, Poledne R, Kazdova L, Skibova J, Maly J. Source: Wiener Klinische Wochenschrift. 2001 September 17; 113(17-18): 661-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11603100

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Multicentre randomized study on the effect of a low-protein diet on the progression of renal failure in childhood: one-year results. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. Author(s): Wingen AM, Fabian-Bach C, Mehls O. Source: Mineral and Electrolyte Metabolism. 1992; 18(2-5): 303-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1465080

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Nitrogen balance studies with amino acid supplemented low-protein diet in uremia. Author(s): Attman PO, Bucht H, Isaksson B, Uddebom G. Source: The American Journal of Clinical Nutrition. 1979 October; 32(10): 2033-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=114043

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Nutritional state in patients on long-term low-protein diet or with nephrotic syndrome. Author(s): Guarnieri GF, Toigo G, Situlin R, Carraro M, Tamaro G, Lucchesli A, Oldrizzi L, Rugiu C, Maschio G. Source: Kidney International. Supplement. 1989 November; 27: S195-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2636656

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Parathormone activity and rate of progression of chronic renal failure in patients on low-protein diet. Author(s): Aparicio M, Gin H, Merville P, Combe C, de Precigout V, Lafage MH, Bouchet JL, Potaux L. Source: Nephron. 1990; 56(3): 333-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2077420

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Plasma lipid and lipoprotein levels in obese post-menopausal women: effects of a short-term low-protein diet and exercise. Author(s): Vermeulen A. Source: Maturitas. 1990 June; 12(2): 121-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2255264

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Practical application of a low-protein diet for Parkinson's disease. Author(s): Riley D, Lang AE. Source: Neurology. 1988 July; 38(7): 1026-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3386817

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Propionyl-CoA carboxylase deficiency: case report, effect of low-protein diet and identification of 3-oxo-2-methylvaleric acid 3-hydroxy-2-methylvaleric acid, and maleic acid in urine. Author(s): Bergstrom T, Greter J, Levin AH, Steen G, Tryding N, Wass U. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 1981 April; 41(2): 117-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7313494

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Protein synthesis in skeletal muscle of uremic patients: effect of low-protein diet and supplementation with ketoacids. Author(s): Jahn H, Rose F, Schmitt R, Melin G, Schohn D, Comte G, Schaetzel S. Source: Mineral and Electrolyte Metabolism. 1992; 18(2-5): 222-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1465063

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Protein turnover and energy metabolism of elderly women fed a low-protein diet. Author(s): Castaneda C, Dolnikowski GG, Dallal GE, Evans WJ, Crim MC. Source: The American Journal of Clinical Nutrition. 1995 July; 62(1): 40-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7598065

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Proteinuria and progression of renal failure in patients on a low-protein diet. Author(s): Aparicio M, Potaux L, Bouchet JL, Morel D, Combe C, Merville P, Gonzales R. Source: Nephron. 1989; 51(2): 292-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2915775

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Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Author(s): Wingen AM, Fabian-Bach C, Schaefer F, Mehls O. Source: Lancet. 1997 April 19; 349(9059): 1117-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9113009

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Rate of progression of renal disease and low-protein diet. Author(s): Martinez-Maldonado M, Sattin RW, Sattin RD. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1998 June; 31(6): 1048-9. Erratum In: Am J Kidney Dis 1998 August; 32(2): 350. Sattin Rd[corrected to Sattin Rw]. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9631853

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Recent advance in the treatment of diabetic nephropathy: low-protein diet. Author(s): Viberti G. Source: J Diabet Complications. 1991 April-September; 5(2-3): 87. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1770062

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Renal clearances of oxypurinol and inulin on an isocaloric, low-protein diet. Author(s): Kitt TM, Park GD, Spector R, Lawton W, Tsalikian E. Source: Clinical Pharmacology and Therapeutics. 1988 June; 43(6): 681-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3378389

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Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal insufficiency. A randomized, controlled trial. Author(s): Castaneda C, Gordon PL, Uhlin KL, Levey AS, Kehayias JJ, Dwyer JT, Fielding RA, Roubenoff R, Singh MF. Source: Annals of Internal Medicine. 2001 December 4; 135(11): 965-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11730397

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Serum oxalic acid in uremia: effect of a low-protein diet supplemented with essential amino acids and ketoanalogues. Author(s): Barsotti G, Cristofano C, Morelli E, Meola M, Lupetti S, Giovannetti S. Source: Nephron. 1984; 38(1): 54-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6472531

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Supplemented low-protein diet and once-weekly hemodialysis. Author(s): Locatelli F, Andrulli S, Pontoriero G, Di Filippo S, Bigi MC. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1994 August; 24(2): 192-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8048424

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Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis. Author(s): Coresh J, Walser M, Hill S. Source: Journal of the American Society of Nephrology : Jasn. 1995 November; 6(5): 1379-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8589312

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The effect of a low-protein diet on serum levels of ceruloplasmin and transferrin in patients with chronic renal failure. Author(s): Marecek Z, Vulterinova M, Skala I, Pechar J, Dobersky P, Schuck O, Nadvornikova H, Heyrovsky I. Source: Clinical Nephrology. 1978 January; 9(1): 38-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=630743

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The nutritive value of Professor Chittenden's low-protein diet. Author(s): Paul A, Greaves JP. Source: The Proceedings of the Nutrition Society. 1969 March; 28(1): 14A-15A. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5786590

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The short-term effects of a low-protein diet in stable renal transplant recipients. Author(s): Windus DW, Lacson S, Delmez JA. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1991 June; 17(6): 693-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2042652

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The use of low-protein diet in chronic renal failure. Author(s): Berlyne GM. Source: British Journal of Urology. 1966 December; 38(6): 613-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5958045

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Therapy of membranous nephropathy: use of low-protein diet. Author(s): Sims S, Rotellar C. Source: Journal of the American Society of Nephrology : Jasn. 1995 July; 6(1): 136-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7579067

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Treatment of hyperornithinaemia and gyrate atrophy of choroid and retina with lowprotein diet. Author(s): Stoppoloni G, Prisco F, Santinelli R, Sicuranza G, Rinaldi E. Source: Lancet. 1982 April 24; 1(8278): 973. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6122812

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Treatment of nephrotic adults with a supplemented, very low-protein diet. Author(s): Walser M, Hill S, Tomalis EA. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1996 September; 28(3): 354-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8804233

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Use of a balanced low-protein diet in chronic renal failure. Author(s): Franklin SS, Gordon A, Kleeman CR, Maxwell MH. Source: Jama : the Journal of the American Medical Association. 1967 November 6; 202(6): 477-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6072315

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CHAPTER 2. NUTRITION AND LOW-PROTEIN DIET Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and low-protein diet.

Finding Nutrition Studies on Low-Protein Diet The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “low-protein diet” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “low-protein diet” (or a synonym): •

Effect of a low-protein diet on doxorubicin pharmacokinetics in the rabbit. Author(s): Gerontology and Clinical Pharmacology Research Unit, VA Medical Center, Boise, Idaho 83702-4598. Source: Cusack, B J Young, S P Loseke, V L Hurty, M R Beals, L Olson, R D CancerChemother-Pharmacol. 1992; 30(2): 145-8 0344-5704

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Effect of nonsupplemented low-protein diet on very late stage CRF. Author(s): Department of Internal Medicine, Division of Nephrology, Showa University Fujigaoka Hospital, Aoba-ku, Yokohama-city, Kanagawa, Japan. [email protected] Source: Ideura, T Shimazui, M Higuchi, K Morita, H Yoshimura, A Am-J-Kidney-Dis. 2003 March; 41(3 Suppl 2): S31-4 1523-6838

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Effects of a low-phosphorus, low-protein diet supplemented with essential amino acids and keto analogues on 'overt' diabetic nephropathy. Author(s): Clinica Medica 1, Universita di Pisa, Italy. Source: Barsotti, G Navalesi, R Morelli, E Giampietro, O Ciardella, F Cupisti, A Giovannetti, S Infusionsther-Klin-Ernahr. 1987 October; 14 Suppl 512-6 0378-0791

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Effects of Gumboro vaccination and low-protein diet on the immune response and performance of broilers. Source: Oyejide, A. Tewe, O. Olaleye, O.D. Trop-Vet. Basel : Karger. 1984. volume 2 (1) page 48-53. 0301-4231

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Effects of subchronic low-protein diet on some tissue glutathione-related enzyme activities in the rat. Source: Warnet, J M Bakar Wesseling, I Thevenin, M Serrano, J J Jacqueson, A Boucard, M Claude, J R Arch-Toxicol-Suppl. 1987; 1145-9 0171-9750

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Increased systolic blood pressure in rats induced by a maternal low-protein diet is reversed by dietary supplementation with glycine. Author(s): Institute of Human Nutrition, Fetal Origins of Adult Disease Research Division, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. [email protected] Source: Jackson, A A Dunn, R L Marchand, M C Langley Evans, S C Clin-Sci-(Lond). 2002 December; 103(6): 633-9 0143-5221

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Vegetarian diet alternated with conventional low-protein diet for patients with chronic renal failure. Author(s): Dipartimento di Medicina Interna, Universita di Pisa, Italia. Source: Cupisti, Adamasco Morelli, Ester Meola, Mario Barsotti, Massimiliano Barsotti, Giuliano J-Ren-Nutr. 2002 January; 12(1): 32-7 1051-2276

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

Nutrition

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to low-protein diet; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Food and Diet Diabetes Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND LOW-PROTEIN DIET Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to low-protein diet. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to low-protein diet and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “low-protein diet” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to low-protein diet: •

A combined casein-free-nicotinamide diet prevents diabetes in the NOD mouse with minimum insulitis. Author(s): Reddy S, Bibby NJ, Wu D, Swinney C, Barrow G, Elliott RB. Source: Diabetes Research and Clinical Practice. 1995 August; 29(2): 83-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8591703

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A low-nitrogen low-phosphorus Vegan diet for patients with chronic renal failure. Author(s): Barsotti G, Morelli E, Cupisti A, Meola M, Dani L, Giovannetti S. Source: Nephron. 1996; 74(2): 390-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8893161

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A low-protein diet for turkey poults. Author(s): Boling SD, Firman JD.

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Source: Poultry Science. 1997 September; 76(9): 1298-301. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9276894 •

A short-term low-protein diet reduces glomerular filtration rate in insulin-dependent diabetes mellitus patients. Author(s): Azevedo MJ, Padilha LM, Gross JL. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 1990; 23(8): 647-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2101087

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A special, supplemented 'vegan' diet for nephrotic patients. Author(s): Barsotti G, Morelli E, Cupisti A, Bertoncini P, Giovannetti S. Source: American Journal of Nephrology. 1991; 11(5): 380-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1809035

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Acid-base balance affects dietary choice in cats. Author(s): Cook NE, Rogers QR, Morris JG. Source: Appetite. 1996 April; 26(2): 175-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8737168

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Advanced therapeutic approaches for the management of uraemia--'the met and unmet needs'. Author(s): Cowgill LD. Source: Journal of Feline Medicine and Surgery. 2003 February; 5(1): 57-67. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12613495

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Allodynia and hyperalgesia evoked by sciatic mononeuropathy in NKI receptor knockout mice. Author(s): Martinez-Caro L, Laird JM. Source: Neuroreport. 2000 April 27; 11(6): 1213-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10817594

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Body composition of patients on a very low-protein diet: a two-year survey with DEXA. Author(s): Chauveau P, Vendrely B, El Haggan W, Barthe N, Rigalleau V, Combe C, Aparicio M. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2003 October; 13(4): 282-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14566765

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Comparison of a vegetable-based (soya) and an animal-based low-protein diet in predialysis chronic renal failure patients. Author(s): Soroka N, Silverberg DS, Greemland M, Birk Y, Blum M, Peer G, Iaina A. Source: Nephron. 1998; 79(2): 173-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9647497

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Crystalline lysine and threonine supplementation of soft red winter wheat or triticale, low-protein diets for growing-finishing swine. Author(s): Myer RO, Brendemuhl JH, Barnett RD. Source: Journal of Animal Science. 1996 March; 74(3): 577-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8707713

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Dietary essential amino acid supplements increase bone strength by influencing bone mass and bone microarchitecture in ovariectomized adult rats fed an isocaloric lowprotein diet. Author(s): Ammann P, Laib A, Bonjour JP, Meyer JM, Ruegsegger P, Rizzoli R. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2002 July; 17(7): 1264-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12096840

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Effect of amino acid supplementation to a low-protein diet on brain neurotransmitters and memory-learning ability of rats. Author(s): Yokogoshi H, Nomura M. Source: Physiology & Behavior. 1991 December; 50(6): 1227-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1686810

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Effect of high temperature and low-protein diets on the performance of growingfinishing pigs. Author(s): Le Bellego L, van Milgen J, Noblet J. Source: Journal of Animal Science. 2002 March; 80(3): 691-701. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11890404

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Effect of low-protein diet supplemented with keto acids on progression of disease in patients with chronic renal failure. Author(s): Deniz Ayli M, Ayli M, Ensari C, Mandiroglu F, Allioglu M. Source: Nephron. 2000 March; 84(3): 288-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10720907

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Effect of low-protein diets on growth performance and body composition of broiler chicks. Author(s): Bregendahl K, Sell JL, Zimmerman DR.

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Source: Poultry Science. 2002 August; 81(8): 1156-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12211308 •

Effect of nonsupplemented low-protein diet on very late stage CRF. Author(s): Ideura T, Shimazui M, Higuchi K, Morita H, Yoshimura A. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S31-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12612948

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Effects of a low-phosphorus, low-protein diet supplemented with essential amino acids and keto analogues on 'overt' diabetic nephropathy. Author(s): Barsotti G, Navalesi R, Morelli E, Giampietro O, Ciardella F, Cupisti A, Giovannetti S. Source: Infusionsther Klin Ernahr. 1987 October; 14 Suppl 5: 12-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3436663

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Effects of low-protein diet supplemented with ketoacids and erythropoietin in chronic renal failure: a long-term metabolic study. Author(s): Teplan V, Schuck O, Knotek A, Hajny J, Horackova M, Skibova J, Maly J. Source: Ann Transplant. 2001; 6(1): 47-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11803607

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Hyperfiltration due to amino and keto acid supplements of low-protein diets: influence on creatinine clearance. Author(s): Gretz N, Meisinger E, Strauch M. Source: Infusionsther Klin Ernahr. 1987 October; 14 Suppl 5: 30-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3436667

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Hyperfiltration due to amino and keto acid supplements of low-protein diets: influence on proteinuria. Author(s): Meisinger E, Gretz N, Strauch M. Source: Infusionsther Klin Ernahr. 1987 October; 14 Suppl 5: 26-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3436666

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Identification of limiting amino acids in methionine- and lysine-supplemented lowprotein diets for turkeys. Author(s): Waibel PE, Carlson CW, Brannon JA, Noll SL. Source: Poultry Science. 2000 September; 79(9): 1299-305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11020075

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Increased systolic blood pressure in rats induced by a maternal low-protein diet is reversed by dietary supplementation with glycine. Author(s): Jackson AA, Dunn RL, Marchand MC, Langley-Evans SC.

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Source: Clinical Science (London, England : 1979). 2002 December; 103(6): 633-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12444916 •

Influence of amino acid supplementation of low-protein diets and metabolizable energy feeding sequence on performance and carcass composition of toms. Author(s): Sell JL, Jeffrey MJ, Kerr BJ. Source: Poultry Science. 1994 December; 73(12): 1867-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7877943

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Influence of protein concentration, amino acid supplementation, and daily time to access to high- or low-protein diets on egg weight and components in laying hens. Author(s): Penz Junior AM, Jensen LS. Source: Poultry Science. 1991 December; 70(12): 2460-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1784567

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Limiting amino acids after methionine and lysine with growing turkeys fed lowprotein diets. Author(s): Waibel PE, Carlson CW, Brannon JA, Noll SL. Source: Poultry Science. 2000 September; 79(9): 1290-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11020074

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Liver desaturase activities and FA composition in monkeys. Effect of a low-protein diet. Author(s): Marin MC, Pucciarelli HM, de Alaniz MJ. Source: Lipids. 2003 May; 38(5): 525-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12880108

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Low-protein diet and kidney function in insulin-dependent diabetic patients with diabetic nephropathy. Author(s): Hansen HP, Christensen PK, Tauber-Lassen E, Klausen A, Jensen BR, Parving HH. Source: Kidney International. 1999 February; 55(2): 621-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9987086

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Polymerization degree of oligomethionine to determine its bioavailability when added to a low-protein diets. Author(s): Kasai T, Tanaka T, Kiriyama S. Source: Bioscience, Biotechnology, and Biochemistry. 1996 May; 60(5): 828-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8704313

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Role of fermentable carbohydrate supplements with a low-protein diet in the course of chronic renal failure: experimental bases. Author(s): Younes H, Alphonse JC, Behr SR, Demigne C, Remesy C.

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Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1999 April; 33(4): 633-46. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10196003 •

Supplementation with gum arabic fiber increases fecal nitrogen excretion and lowers serum urea nitrogen concentration in chronic renal failure patients consuming a lowprotein diet. Author(s): Bliss DZ, Stein TP, Schleifer CR, Settle RG. Source: The American Journal of Clinical Nutrition. 1996 March; 63(3): 392-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8602598

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The effect of a low-protein diet and dietary supplementation of threonine on tyrosine and 2-(2-nitro-4-trifluoromethylbenzoyl) cyclohexane-1,3-dione-induced corneal lesions, the extent of tyrosinemia, and the activity of enzymes involved in tyrosine catabolism in the rat. Author(s): Lock EA, Gaskin P, Ellis MK, Robinson M, Provan WM, Smith LL. Source: Toxicology and Applied Pharmacology. 1998 May; 150(1): 125-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9630461

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The effect of single large doses of choline or methionine on phospholipid turnover in normal human subjects maintained on a low-protein diet for seven days. Author(s): CORNATZER WE, CAYER D, LAMBETH WA Jr. Source: The Journal of Laboratory and Clinical Medicine. 1951 November; 38(5): 705-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14889056

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to low-protein diet; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Kidney Stones Source: Healthnotes, Inc.; www.healthnotes.com Migraine Headaches Source: Healthnotes, Inc.; www.healthnotes.com Parkinson's Disease Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. BOOKS ON LOW-PROTEIN DIET Overview This chapter provides bibliographic book references relating to low-protein diet. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on low-protein diet include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “low-protein diet” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on low-protein diet: •

Nutrition Counseling Skills for Medical Nutrition Therapy Source: Gaithersburg, MD: Aspen Publishers, Inc. 1997. 409 p. Contact: Available from Aspen Publishers, Inc. Fulfillment, 7201 McKinney Circle, Frederick, MD 21704. (800) 234-1660 or (800) 638-8437. PRICE: $55.00. ISBN: 0834207559. Summary: This book focuses on increasing the effectiveness of nutrition counselors as facilitators of behavioral change. The author uses the term 'nutrition counselor' to describe all health professionals involved in counseling clients or patients to provide dietary information or facilitate dietary adherence. The author encourages readers to apply communication and counseling skills and strategies to the discipline of nutrition, particularly in situations that require specific dietary modifications. Ten chapters cover an overview of nutrition counseling; communication skills; counseling skills to facilitate self-management; nutrition counseling in treatment and prevention of obesity, coronary

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heart disease, diabetes, renal disease, and hypertension; nutrition counseling for cancer risk prevention; and evaluation and follow up strategies. The chapter on renal disease covers theories and facts about nutrition and chronic renal failure (CRF), eating patterns in the treatment of renal disease, inappropriate eating behaviors, the assessment of eating behaviors, and treatment strategies. Eighteen patient education materials and monitoring forms are included in this chapter, including those designed for a lowprotein diet. The book concludes with eight appendices, including a checklist of nutrition counselor self-image, a checklist of nutrition counselor's nonverbal behavior, measures of nutritional status, a behavioral chart and log, thoughts related to food, a daily record of cognitive restructuring, and answers to the review questions at the end of each chapter. Each chapter includes references, and a subject index concludes the text. (AA-M). •

Healthy Food Guide for People with Chronic Kidney Disease. 2nd ed Source: Chicago, IL: American Dietetic Association. 2002. 60 p. Contact: Available from American Dietetic Association. 120 South Riverside Plaza, Chicago, IL 60606-6695. (800) 877-1600, ext. 5000. Fax (312) 899-4899. E-mail: [email protected]. Website: www.eatright.org. PRICE: Package of 10: $27.00 for member, $36.00 for nonmember. ISBN: 880914017. Summary: This booklet helps patients with chronic kidney disease (CKD) plan nutritious meals and prevent progression of their illness. When the kidneys fail, wastes that normally leave the body in the urine remain in the blood. Eating the right types and amounts of food can help to control this waste buildup. The foods in the booklet are divided into groups according to the amounts of protein, sodium, and phosphorus they contain. Readers are encouraged to work closely with their dietitian to individualize an appropriate diet. The booklet offers seven chapters: getting started on a low-protein diet, protein choices, fruit choices, calories and flavoring choices, diabetes and chronic kidney disease, vegetarian protein choices, and meal planning. The information is presented in list and chart format, with side bars highlighting important details. 1 figure. 1 table.

Chapters on Low-Protein Diet In order to find chapters that specifically relate to low-protein diet, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and low-protein diet using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “lowprotein diet” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on low-protein diet: •

Role of Nutrition in Prevention of the Progression of Renal Disease Source: in McCormick, D.B., Bier, D.M., and Goodridge, A.G., eds. Annual Review of Nutrition. Palo Alto, CA: Annual Reviews Inc. 1997. Volume 17: 435-455. Contact: Available from Annual Reviews Inc. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (800) 523-8635. Fax (415) 424-0910. PRICE: $60.00. ISBN:

Books

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0824328175. ISSN: 01999885. Individual article reprints available from Annual Reviews Preprints and Reprints. Summary: This article explores the role of nutrition in prevention of the progression of renal disease. In rats with renal disease, low-protein diets slow the decline in renal function, histologic damage, and mortality. Low-protein (and phosphorus) diets can also ameliorate uremic symptoms, secondary hyperparathyroidism, and metabolic acidosis in patients with chronic renal failure (CRF). Albeit controversial, evidence also suggests that dietary protein restriction can slow the rate of progression of renal failure and the time until end-stage renal disease (ESRD). These dietary regimens appear to be safe, and patients with CRF are able to activate normal compensatory mechanisms designed to conserve lean body mass when dietary protein intake is restricted. When low-protein diets are prescribed, patients should be closely monitored to assess dietary compliance and to ensure nutritional adequacy. Evidence that the spontaneous intake of dietary protein decreases in patients with progressive CRF who consume unrestricted diets should not be construed as an argument to restrict dietary protein intake in order to minimize complications of renal failure while preserving nutritional status. 5 figures. 1 table. 71 references. (AA-M). •

Nutrition Counseling in Treatment of Renal Disease Source: in Snetselaar, L.G. Nutrition Counseling Skills for Medical Nutrition Therapy. Gaithersburg, MD: Aspen Publishers, Inc. 1997. p. 271-309. Contact: Available from Aspen Publishers, Inc. Fulfillment, 7201 McKinney Circle, Frederick, MD 21704. (800) 234-1660 or (800) 638-8437. PRICE: $55.00. ISBN: 0834207559. Summary: This chapter is from a textbook that focuses on increasing the effectiveness of nutrition counselors as facilitators of behavioral change. The author uses the term 'nutrition counselor' to describe all health professionals involved in counseling clients or patients to provide dietary information or facilitate dietary adherence. This chapter addresses nutrition counseling in the treatment of renal disease. The chapter covers theories and facts about nutrition and chronic renal failure (CRF), eating patterns in the treatment of renal disease, inappropriate eating behaviors, the assessment of eating behaviors, and treatment strategies. Problems with low-protein eating patterns fall into the three categories mentioned for other diets: lack of knowledge, forgetfulness, and lack of commitment. Cueing devices can be helpful in reminding patients to take medications and follow low-protein eating patterns. The author emphasizes that lack of commitment might be approached with strategies such as self-monitoring, contracting, reinforcement, and positive thinking. Eighteen patient education materials and monitoring forms are contained in this chapter, including those designed for a lowprotein diet. The focus is on the outpatient in the predialysis state. 18 appendices. 47 references. (AA-M).

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Influences of Diet on the Progression of Chronic Renal Insufficiency Source: in Kopple, J.D. and Massry, S.G. Nutritional Management of Renal Disease. Baltimore, MD: Williams and Wilkins. 1997. p. 317-340. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This chapter on the influences of diet on the progression of chronic renal insufficiency is from a medical textbook on nutrition and metabolism of individuals

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with renal disease or renal failure. The author notes that, in spite of intensive investigation, the mechanisms by which a low-protein diet could change the rate of loss of renal function have not been fully elucidated. In addition, the underlying mechanisms causing progressive loss of renal function have not been unequivocally identified, even in experimental animals. The author provides information designed to help readers make a rational decision about whether to implement nutritional therapy for a patient with progressive loss of renal function. Topics covered include the nutritional adequacy of restricted diets; monitoring changes in renal function, including serum creatinine; low protein diets used to slow progress; assessment of dietary compliance; urea generation and protein nitrogen appearance; diabetic nephropathy and dietary protein restriction; supplemented low protein diets; and the Modification of Diet in Renal Disease (MDRD) Study. The author concludes that compliance with dietary protein restriction can be assessed reliably using available methods, and dietary regimens do not cause malnutrition if effort is made to ensure the nutritional adequacy of the diet actually ingested. Because there is evidence that dietary manipulation can slow progression in some patients, a low protein diet should be instituted in patients who have documented progressive renal insufficiency in spite of adequate treatment of hypertension. 4 figures. 1 table. 83 references. (AA-M). •

Requirements for Protein, Calories, and Fat in the Predialysis Patient Source: in Mitch, W.E. and Klahr, S., eds. Nutrition and the Kidney. 2nd ed. Boston, MA: Little, Brown and Company. 1993. p. 185-212. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $94.95. ISBN: 0316575003. Summary: This chapter, from a book about nutritional requirements during kidney disease, discusses the requirements for protein, calories, and fat in the predialysis patient. The author also reviews the evidence supporting the adequacy of currently recommended low-protein diets; discusses the mechanism(s) responsible for successful adaptation to dietary protein restriction; and outlines methods for outpatient assessment of dietary adequacy and compliance. Specific topics include factors influencing protein turnover in uremia; the conventional low-protein diet; essential amino acidsupplemented diet regimens; ketoacid-supplemented diet regimens; dietary regimens for mild, moderate, and advanced chronic renal failure (CRF); abnormalities in glucose and lipid metabolism; and the treatment of hyperlipidemia. 4 figures. 4 tables. 136 references.

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CHAPTER 5. PERIODICALS AND NEWS ON LOW-PROTEIN DIET Overview In this chapter, we suggest a number of news sources and present various periodicals that cover low-protein diet.

News Services and Press Releases One of the simplest ways of tracking press releases on low-protein diet is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “low-protein diet” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to low-protein diet. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “low-protein diet” (or synonyms).

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “low-protein diet” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “low-protein diet” (or synonyms). If you know the name of a company that is relevant to low-protein diet, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “low-protein diet” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly

Periodicals and News

37

to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “low-protein diet” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on low-protein diet: •

Restricting Protein Slows Progression of Renal Disease Source: Network News. Number 6: 1-2. April 1996. Contact: Available from IgA Nephropathy Support Network. 234 Summit Avenue, Jenkintown, PA 19046. (215) 884-9038. Summary: This article from a patient education newsletter updates readers on research showing that dietary protein restriction can slow the progression of renal disease. The article briefly reports on the Modification of Diet in Renal Disease (MDRD) study, which demonstrated that a low-protein diet initially reduces the single-nephron glomerular filtration rate (GFR), but subsequently slows the progression of renal disease. The author then discusses risk factors for malnutrition, how high protein consumption can injure the kidneys, decline in renal blood flow and GFR with aging, prognostic considerations, and reasons for turning vegetarian for people with IgA nephropathy. 12 references.

Academic Periodicals covering Low-Protein Diet Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to low-protein diet. In addition to these sources, you can search for articles covering low-protein diet that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

39

CHAPTER 6. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for lowprotein diet. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with low-protein diet. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

40

Low-Protein Diet

The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to low-protein diet: Sodium Phenylbutyrate •

Systemic - U.S. Brands: Buphenyl http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202916.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

41

APPENDICES

43

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute8: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

8

These publications are typically written by one or more of the various NIH Institutes.

44

Low-Protein Diet

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:10 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

9

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 10 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway11 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “low-protein diet” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 2668 5 835 4 43 3555

HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.15 Simply search by “low-protein diet” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

11

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

12

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 13 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 14 15

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources

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Coffee Break: Tutorials for Biologists16 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.17 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.18 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

16 Adapted 17

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 18 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

49

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on low-protein diet can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to low-protein diet. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to low-protein diet. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “low-protein diet”:

50

Low-Protein Diet

Weight Loss and Dieting http://www.nlm.nih.gov/medlineplus/weightlossanddieting.html Dietary Fats http://www.nlm.nih.gov/medlineplus/dietaryfats.html Dietary Proteins http://www.nlm.nih.gov/medlineplus/dietaryproteins.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on low-protein diet. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Diabetic Low Protein Way Source: Minneapolis, MN: Dialyrn Renal Education System. 1991. 24 p. Contact: Available from Dialyrn Renal Education System. Regional Kidney Disease Program, 914 South Eighth Street, Minneapolis, MN 55404. (612) 347-5949. PRICE: $3 (bulk prices available). Order Number: 310-C. Summary: This booklet lists 3 days worth of sample menus for a low-protein diet for the person with diabetes. Blank spaces are left throughout the booklet to individualize the meal plan to each patient. For each day, a suggested meal plan for breakfast, lunch, dinner, and snacks is listed with the appropriate food group portions noted for ease of use. Also included are nine recipes.

•

Diabetes and Kidney Disease Source: New York, NY: Juvenile Diabetes Foundation International. 199x. [4 p.]. Contact: Available from Juvenile Diabetes Foundation International. 120 Wall Street, New York, NY 10005-4001. (800) 533-2873 or (212) 785-9500. Website: www.jdfcure.com. PRICE: Single copy free; bulk copies available. Summary: This brochure discusses the effects of diabetes on the kidneys. People with either type 1 or type 2 diabetes are at risk for developing kidney disease. Diabetic nephropathy occurs because diabetes causes a change in the kidneys, killing some cells and causing the remaining ones to work harder. This eventually damages the small blood vessels in the kidneys, thus interfering with the filtering process. Untreated

Patient Resources

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kidney damage can become renal failure. Protein in the urine is an early sign of kidney damage, so doctors perform tests to assess renal function as part of regular examinations. After diabetic kidney disease is diagnosed, various measures are used to slow the progression to end-stage renal disease. They include controlling blood sugar, high blood pressure, and urinary tract infections; using angiotensin converting enzyme inhibitors; and maintaining a low-protein diet. Treatment options for failed kidneys include hemodialysis and peritoneal dialysis, continuous ambulatory peritoneal dialysis, and kidney transplantation. •

Kidney Disease of Diabetes Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1995. 6 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text available online at no charge; single copy free; bulk copies available. Summary: This fact sheet informs readers about end-stage renal (kidney) disease (ESRD) associated with diabetes. The fact sheet stresses that, even when drugs and diet are able to control diabetes, the disease can lead to nephropathy and ESRD. Topics include noninsulin-dependent diabetes (NIDDM); insulin-dependent diabetes (IDDM); the five stages in the progression to ESRD in people with diabetes; the effects of high blood pressure; steps to prevent and slow kidney disease, including blood pressure medicines, low-protein diets, and intensive diabetes management; dialysis and transplantation; and present research strategies in this area. The fact sheet concludes with a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 1 figure. 3 references. The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to low-protein diet. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

52

Low-Protein Diet

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to low-protein diet. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with low-protein diet. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about low-protein diet. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “low-protein diet” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit

Patient Resources

53

your search to “Organizations” and “low-protein diet”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “low-protein diet” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “low-protein diet” (or a synonym) into the search box, and click “Submit Query.”

55

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.19

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

19

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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Low-Protein Diet

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)20: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

20

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

57

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

59

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

61

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

63

LOW-PROTEIN DIET DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH]

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Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaptonuria: An inborn error of amino acid metabolism resulting from a defect in the enzyme homogentisate 1,2-dioxygenase and causing an accumulation of homogentisic acid in the urine. The condition is characterized by ochronosis in various tissues and arthritis. [NIH]

Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another

Dictionary 65

living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigens: Substances that are recognized by the immune system and induce an immune reaction. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Asparaginase: A hydrolase enzyme that converts L-asparagine and water to L-aspartate and NH3. EC 3.5.1.1. [NIH] Aspartate: A synthetic amino acid. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Azotemia: An excess of urea or other nitrogenous compounds in the blood. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning

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technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Viscosity: The internal resistance of the blood to shear forces. The in vitro measure of whole blood viscosity is of limited clinical utility because it bears little relationship to the actual viscosity within the circulation, but an increase in the viscosity of circulating blood can contribute to morbidity in patients suffering from disorders such as sickle cell anemia and polycythemia. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Calcifediol: The major circulating metabolite of vitamin D3 produced in the liver and the best indicator of the body's vitamin D stores. It is effective in the treatment of rickets and osteomalacia, both in azotemic and non-azotemic patients. Calcifediol also has mineralizing properties. [NIH] Calcitriol: The physiologically active form of vitamin D. It is formed primarily in the kidney by enzymatic hydroxylation of 25-hydroxycholecalciferol (calcifediol). Its production is stimulated by low blood calcium levels and parathyroid hormone. Calcitriol increases intestinal absorption of calcium and phosphorus, and in concert with parathyroid hormone increases bone resorption. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the

Dictionary 67

alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or

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transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH]

Dictionary 69

Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Creatinine clearance: A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Daunorubicin: Very toxic anthracycline aminoglycoside antibiotic isolated from Streptomyces peucetius and others, used in treatment of leukemias and other neoplasms. [NIH]

Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH]

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Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Diuresis: Increased excretion of urine. [EU] Doxorubicin: Antineoplastic antibiotic obtained from Streptomyces peucetics. It is a hydroxy derivative of daunorubicin and is used in treatment of both leukemia and solid tumors. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH]

Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain

Dictionary 71

microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

Extracellular: Outside a cell or cells. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Forearm: The part between the elbow and the wrist. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH]

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Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gum Arabic: Powdered exudate from various Acacia species, especially A. senegal (Leguminosae). It forms mucilage or syrup in water. Gum arabic is used as a suspending agent, excipient, and emulsifier in foods and pharmaceuticals. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hepatic: Refers to the liver. [NIH] Hepatocyte: A liver cell. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH]

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Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Instillation: . [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU]

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Intestinal: Having to do with the intestines. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Kinetic: Pertaining to or producing motion. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukaemia: An acute or chronic disease of unknown cause in man and other warm-blooded animals that involves the blood-forming organs, is characterized by an abnormal increase in the number of leucocytes in the tissues of the body with or without a corresponding increase of those in the circulating blood, and is classified according of the type leucocyte most prominently involved. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol,

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and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Metabolic acidosis: (met-ah-BOL-ik as-id-O-sis): A condition in which the blood is too acidic. It may be caused by severe illness or sepsis (bacteria in the bloodstream). [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH]

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Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Nephropathy: Disease of the kidneys. [EU] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Nephrotic Syndrome: Clinical association of heavy proteinuria, hypoalbuminemia, and generalized edema. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Nutritive Value: An indication of the contribution of a food to the nutrient content of the diet. This value depends on the quantity of a food which is digested and absorbed and the amounts of the essential nutrients (protein, fat, carbohydrate, minerals, vitamins) which it contains. This value can be affected by soil and growing conditions, handling and storage, and processing. [NIH]

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Ochronosis: Deposition of polymerized homogentisic acid as a brown-black pigment in the connective tissue. It occurs in alkaptonuria, but has also been observed in connection with exposure to certain chemicals (e.g., phenol, trinitrophenol, benzene derivatives). [NIH] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteodystrophy: Defective bone formation. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Oxalic Acid: A strong dicarboxylic acid occurring in many plants and vegetables. It is produced in the body by metabolism of glyoxylic acid or ascorbic acid. It is not metabolized but excreted in the urine. It is used as an analytical reagent and general reducing agent. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxypurinol: A xanthine oxidase inhibitor. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Peptide: Any compound consisting of two or more amino acids, the building blocks of

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proteins. Peptides are combined to make proteins. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneal Dialysis, Continuous Ambulatory: Portable peritoneal dialysis using the continuous (24 hours a day, 7 days a week) presence of peritoneal dialysis solution in the peritoneal cavity except for periods of drainage and instillation of fresh solution. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH]

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Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Progressive disease: Cancer that is increasing in scope or severity. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and

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control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol

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triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of

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another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a

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protein. It occurs on the ribosome and is unidirectional. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Veins: The vessels carrying blood toward the heart. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH]

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Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Xanthine: An urinary calculus. [NIH] Xanthine Oxidase: An iron-molybdenum flavoprotein containing FAD that oxidizes hypoxanthine, some other purines and pterins, and aldehydes. Deficiency of the enzyme, an autosomal recessive trait, causes xanthinuria. EC 1.1.3.22. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

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INDEX A Abdominal, 63, 77, 78 Acceptor, 63, 77 Acetylcholine, 63, 67, 76 Acidosis, 63 Adaptation, 34, 63 Adenosine, 63, 78, 82 Adjustment, 63 Adverse Effect, 63, 81 Affinity, 63, 81 Age of Onset, 63, 83 Albumin, 6, 8, 64, 75, 78 Algorithms, 64, 66 Alkaline, 63, 64, 67 Alkaptonuria, 9, 64, 77 Alprenolol, 64, 75 Alternative medicine, 36, 64 Amino acid, 5, 7, 10, 13, 14, 16, 20, 25, 26, 27, 34, 64, 65, 72, 74, 75, 77, 78, 79, 81, 82, 83 Ammonia, 64, 83 Anemia, 64, 66 Angina, 64, 75 Angina Pectoris, 64, 75 Angiotensin converting enzyme inhibitor, 51, 64 Anions, 64 Anorexia, 64, 83 Antagonism, 64, 82 Antibiotic, 65, 69, 70 Anticoagulant, 65, 79 Antigens, 65, 73 Antioxidant, 65 Apolipoproteins, 65, 75 Arterial, 65, 67, 73, 79, 82 Arteries, 65, 66, 69, 75 Arterioles, 65, 66, 67 Artery, 65, 69, 82 Ascorbic Acid, 9, 65, 73, 77 Asparaginase, 11, 65 Aspartate, 65 Atrophy, 17, 65 Azotemia, 65, 83 B Bacteria, 65, 70, 75, 81, 83 Bacterial Physiology, 63, 65 Basophils, 65, 74 Bilirubin, 64, 65

Bioavailability, 27, 65 Biotechnology, 6, 27, 36, 45, 65 Biotransformation, 66 Bladder, 66, 69, 83 Blood Coagulation, 66, 67, 82 Blood Glucose, 66, 72, 73 Blood pressure, 4, 51, 66, 67, 73, 75, 81 Blood vessel, 50, 64, 66, 71, 72, 74, 82, 83 Blood Viscosity, 8, 66 Body Composition, 25, 66 Body Fluids, 66, 81 Bone Marrow, 66, 71, 76, 81 Bronchi, 66, 71, 82 Bronchial, 66, 82 Bronchitis, 66, 67 C Calcifediol, 66 Calcitriol, 11, 66 Calcium, 11, 66, 68, 77 Capillary, 67, 72, 83 Capsules, 67, 71, 72 Captopril, 8, 67 Carbohydrate, 9, 27, 67, 76 Carcinogenic, 67, 73 Cardiac, 67, 71, 75, 76 Case report, 15, 67 Catabolism, 3, 16, 28, 67 Cell, 9, 65, 66, 67, 68, 70, 71, 72, 73, 74, 76, 78, 80, 81, 82 Central Nervous System, 63, 67, 77, 82 Cholesterol, 67, 68, 69, 74, 75 Cholesterol Esters, 67, 74 Choline, 28, 67 Choroid, 17, 67, 80 Chronic Disease, 67, 74 Chronic Obstructive Pulmonary Disease, 10, 67 Chylomicrons, 68, 75 Clinical trial, 6, 45, 68, 69, 76, 80 Cloning, 65, 68 Coenzyme, 65, 68 Cognitive restructuring, 32, 68 Collagen, 64, 68, 71 Colloidal, 64, 68 Complement, 68, 69, 78 Complementary and alternative medicine, 23, 29, 68 Complementary medicine, 23, 69

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Compliance, 4, 5, 7, 10, 33, 34, 69 Computational Biology, 45, 69 Confusion, 69, 83 Connective Tissue, 65, 66, 68, 69, 71, 77 Contraindications, ii, 69 Controlled study, 5, 13, 69 Coronary, 31, 64, 69, 75 Coronary heart disease, 32, 69 Coronary Thrombosis, 69, 75 Cortisol, 64, 69 Creatinine, 4, 26, 34, 69, 83 Creatinine clearance, 4, 26, 69 Curative, 69, 82 Cyclic, 69, 80, 82 D Daunorubicin, 69, 70 Deamination, 69, 83 Density, 70, 75 Diabetes Mellitus, 11, 70, 72 Diagnostic procedure, 36, 70 Dialyzer, 70, 72 Diastolic, 70, 73 Dietitian, 32, 70 Direct, iii, 39, 70, 80, 82 Diuresis, 70, 82 Doxorubicin, 20, 70 Drug Interactions, 40, 70 E Edema, 70, 74, 76, 83 Effector, 63, 68, 70 Effector cell, 70 Efficacy, 3, 70 Electrolyte, 9, 10, 11, 14, 15, 70, 81, 83 Electrons, 65, 70, 77 Emphysema, 67, 70 Enalapril, 12, 70 Encephalopathy, 13, 70 Endogenous, 7, 70 Endotoxic, 70, 74 Endotoxins, 68, 70, 74 End-stage renal, 4, 33, 51, 67, 71, 78 Energy Intake, 5, 71 Environmental Health, 44, 46, 71 Enzymatic, 64, 66, 67, 68, 71 Enzyme, 8, 20, 64, 65, 68, 70, 71, 78, 80, 82, 84 Eosinophils, 71, 74 Epinephrine, 71, 76, 83 Erythropoietin, 10, 13, 26, 71 Excipient, 71, 72 Exogenous, 66, 67, 70, 71, 83 Extensor, 71, 79

Extracellular, 69, 71, 81 Exudate, 71, 72 F Family Planning, 45, 71 Fat, 8, 34, 66, 69, 71, 74, 76 Fetus, 71 Filtration, 4, 71 Forearm, 66, 71 G Gas, 64, 71, 72, 76, 81 Gelatin, 71, 72, 82 Gene, 66, 72 Glomerular, 4, 12, 24, 37, 72, 74, 80 Glomerular Filtration Rate, 4, 24, 37, 72 Glomerulus, 72 Glucose, 7, 34, 65, 66, 70, 72, 73 Glucose Intolerance, 70, 72 Glycine, 20, 26, 64, 72, 76 Governing Board, 72, 79 Gum Arabic, 28, 72 H Hemodialysis, 16, 51, 70, 72, 74 Hemoglobin, 64, 72, 74 Hepatic, 64, 72 Hepatocyte, 11, 72 Hormonal, 65, 72 Hormone, 66, 69, 71, 72, 73, 80, 82 Hydrogen, 63, 67, 72, 73, 75, 77 Hydrophobic, 73, 74 Hydroxylation, 66, 73 Hydroxyproline, 64, 68, 73 Hyperalgesia, 24, 73 Hyperlipidemia, 34, 73 Hypertension, 8, 32, 34, 70, 73, 75, 83 I Immune response, 9, 20, 73, 83 Immune system, 65, 70, 73 Immunogenic, 73, 74 In situ, 31, 73 In vitro, 66, 73 Infarction, 69, 73, 75 Infection, 73 Inflammation, 64, 66, 71, 73, 78 Initiation, 10, 73 Instillation, 73, 78 Insulin, 7, 10, 11, 24, 27, 51, 73, 83 Insulin-dependent diabetes mellitus, 24, 73 Insulin-like, 10, 11, 73 Intermittent, 73, 78 Interstitial, 73, 80 Intestinal, 66, 74

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Inulin, 16, 72, 74 Ion Channels, 74 Ischemia, 64, 65, 74 K Kb, 44, 74 Keto, 10, 13, 20, 25, 26, 34, 74 Kidney Disease, 4, 8, 10, 11, 12, 15, 16, 17, 26, 28, 32, 34, 44, 50, 51, 74 Kidney Failure, 71, 74 Kidney Transplantation, 51, 74 Kinetic, 74 L Leucine, 5, 74 Leucocyte, 74 Leukaemia, 11, 74 Leukemia, 70, 74 Leukocytes, 8, 65, 66, 71, 74, 76 Ligaments, 69, 74 Lipid, 14, 34, 65, 67, 73, 74 Lipid A, 14, 74 Lipopolysaccharides, 74 Lipoprotein, 14, 74, 75 Liver, 27, 63, 64, 66, 71, 72, 75, 80, 83 Low-density lipoprotein, 75 Lymphocytes, 74, 75 Lysine, 25, 26, 27, 75 M Malnutrition, 34, 37, 64, 65, 75 MEDLINE, 45, 75 Melanin, 75, 78, 83 Membrane, 67, 68, 70, 74, 75, 77, 78, 80, 81, 84 Memory, 25, 64, 75 Mental, iv, 5, 44, 46, 69, 75, 83 Metabolic acidosis, 33, 75 Methionine, 26, 27, 28, 75, 81 Metoprolol, 12, 75 MI, 61, 75 Microbiology, 63, 75 Modification, 34, 37, 64, 75 Molecular, 45, 47, 65, 69, 75 Molecule, 68, 70, 75, 77, 80 Monitor, 69, 75 Monocytes, 74, 76 Multicenter study, 4, 10, 76 Myocardium, 64, 75, 76 N Nausea, 76, 83 Necrosis, 73, 75, 76 Nephropathy, 5, 12, 15, 17, 20, 26, 27, 34, 37, 50, 51, 74, 76 Nephrosis, 76

Nephrotic, 6, 14, 17, 24, 76 Nephrotic Syndrome, 14, 76 Neuromuscular, 63, 76, 83 Neurons, 76, 82 Neurotransmitter, 63, 64, 72, 74, 76, 80 Neutrophils, 74, 76 Nitrogen, 4, 5, 14, 23, 28, 34, 76 Nucleic acid, 76 Nutritional Status, 4, 32, 33, 76 Nutritive Value, 16, 76 O Ochronosis, 64, 77 Odour, 77, 83 Optic Nerve, 77, 80 Osmotic, 64, 77 Osteodystrophy, 13, 77 Outpatient, 33, 34, 77 Oxalic Acid, 16, 77 Oxidation, 5, 63, 65, 66, 77 Oxypurinol, 16, 77 P Palliative, 77, 82 Pancreas, 63, 73, 77 Parathyroid, 66, 77 Parathyroid hormone, 66, 77 Parenteral, 71, 77 Pathologic, 63, 69, 77, 79, 80 Patient Education, 32, 33, 37, 50, 56, 58, 61, 77 Peptide, 64, 77, 79 Peritoneal, 51, 78 Peritoneal Cavity, 78 Peritoneal Dialysis, 51, 78 Peritoneal Dialysis, Continuous Ambulatory, 51, 78 Peritoneum, 78 Pharmacokinetic, 78 Pharmacologic, 78, 82 Phenylalanine, 78, 83 Phospholipids, 71, 74, 78 Phosphorus, 11, 20, 23, 26, 32, 33, 66, 67, 78 Physiologic, 74, 78, 80 Plants, 67, 72, 74, 77, 78 Plasma, 9, 11, 14, 64, 67, 71, 72, 74, 75, 78, 80 Plasma protein, 64, 78 Pneumonia, 69, 78 Polycystic, 8, 78 Polypeptide, 64, 68, 79, 84 Posterior, 67, 77, 79, 80 Practice Guidelines, 46, 79

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Precursor, 67, 70, 71, 78, 79, 83 Progression, 3, 4, 5, 7, 8, 9, 11, 12, 13, 14, 15, 25, 32, 33, 37, 51, 79 Progressive, 4, 33, 34, 67, 76, 79, 80 Progressive disease, 4, 79 Prophylaxis, 79, 83 Protein C, 27, 32, 37, 64, 65, 74, 79, 83 Protein S, 37, 66, 79 Proteins, 11, 50, 64, 65, 68, 75, 76, 78, 79, 81, 82, 83 Proteinuria, 4, 15, 26, 76, 79 Pruritus, 79, 83 Psoriasis, 13, 79 Public Policy, 45, 79 Publishing, 6, 79 Pulmonary, 66, 74, 79, 83 Pulmonary Artery, 66, 79, 83 R Random Allocation, 79, 80 Randomization, 4, 80 Randomized, 4, 5, 12, 13, 14, 16, 70, 80 Reagent, 77, 80 Receptor, 24, 63, 80 Recombinant, 13, 80 Refer, 1, 68, 80 Regimen, 70, 80 Renal failure, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 20, 23, 25, 26, 27, 28, 32, 33, 34, 51, 78, 80, 83 Renin, 67, 80 Renin-Angiotensin System, 67, 80 Resorption, 66, 80 Retina, 17, 67, 77, 80, 84 Risk factor, 37, 80 S Sclera, 67, 80 Screening, 11, 68, 80 Second Messenger Systems, 80 Secretion, 73, 80, 81 Sensibility, 73, 81 Sepsis, 75, 81 Serum, 6, 16, 28, 34, 64, 68, 75, 81 Side effect, 39, 63, 81, 82 Signs and Symptoms, 81, 83 Skeletal, 15, 81 Skeleton, 81 Sodium, 7, 32, 40, 81 Solid tumor, 70, 81 Specialist, 52, 81 Species, 71, 72, 81, 83 Stem Cells, 71, 81 Suction, 71, 81

Sulfur, 75, 81 Supplementation, 13, 15, 20, 25, 26, 27, 28, 81 Synapses, 81 Systemic, 40, 66, 71, 73, 82 Systolic, 4, 20, 26, 73, 82 Systolic blood pressure, 4, 20, 26, 82 T Theophylline, 10, 82 Therapeutics, 16, 40, 82 Threonine, 25, 28, 82 Threshold, 73, 82 Thrombin, 79, 82 Thrombomodulin, 79, 82 Thyroid, 77, 82, 83 Thyroxine, 64, 78, 82 Tissue, 20, 65, 66, 67, 69, 70, 71, 73, 74, 75, 76, 78, 80, 81, 82, 83 Tooth Preparation, 63, 82 Toxic, iv, 69, 82 Toxicity, 70, 82 Toxicokinetics, 82 Toxicology, 28, 46, 82 Transfection, 65, 82 Translation, 64, 82 Transplantation, 7, 12, 13, 51, 68, 83 Type 2 diabetes, 50, 83 Tyrosine, 28, 83 U Uraemia, 24, 83 Urea, 4, 5, 28, 34, 65, 83 Uremia, 7, 14, 16, 34, 74, 80, 83 Ureters, 83 Urethra, 83 Urinary, 4, 8, 51, 83, 84 Urinary tract, 51, 83 Urinary tract infection, 51, 83 Urine, 5, 15, 32, 51, 64, 66, 69, 70, 77, 79, 83 V Vaccination, 20, 83 Vaccines, 83 Vascular, 67, 73, 83 Veins, 66, 83 Ventricle, 79, 82, 83 Venules, 66, 67, 83 Veterinary Medicine, 45, 84 Viscosity, 66, 84 Vitreous, 80, 84 Vitreous Body, 80, 84 X Xanthine, 77, 84 Xanthine Oxidase, 77, 84

89

Z

Zymogen, 79, 84

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