Renal focal tubulointerstitial fibrosis with short bowel syndrome: report of a case.

Department of Pediatric Surgery, Akita University School of Medicine, Akita 010-8543, Japan.
Surgery Today (Impact Factor: 1.21). 02/2002; 32(7):646-50. DOI: 10.1007/s005950200118
Source: PubMed

ABSTRACT We report a male patient with short bowel syndrome (SBS) and renal focal tubulointerstitial fibrosis (FTIF). Seven years after surgery, he was introduced to us due to severe undernutrition, an impairment of growth hormone (GH) secretion, and abnormally low levels of plasma citrulline and arginine at 11 years 7 months of age, just before nutritional support using total parenteral nutrition (TPN) was begun. Thereafter, the support was changed to home TPN with GH supplementation. After an improvement of the disorders, GH was stopped at 17 years 3 months of age. However, hyperuricemia appeared and a renal biopsy revealed FTIF at 20 years of age. Home TPN was continued twice a week because the plasma arginine level was still low. His follow-up biopsy at 23 years of age showed morphometric amelioration. Arginine deficiency following SBS may be associated with FTIF. The cause of hyperuricemia after SBS therefore needs to be investigated in detail.

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    ABSTRACT: Four-week-old male Sprague-Dawley rats underwent a 90% small bowel resection. From the fourth day after surgery, they were divided into group 1 and 2, and pair-fed by elemental diets (0.8 kcal/mL, 50 mL/day) with L-arginine (n = 10) or L-glycine (n = 11) as an isonitrogenous and isoenergetic supplement for 3 weeks. They were compared with each other 3 weeks after surgery. A statistical analysis was performed using the unpaired Student's t test and the one-way factorial analysis of variance (ANOVA) using Bonferroni/Dunn multiple comparison test. A Pvalue of < .05 was considered significant. There were no significant differences between the two groups in food intake, body weight, tail length, residual ileal length, and plasma IGF-I level. However, the mean height of ileal villi in group 1 showed higher than that in group 2 (P < .01). Growth hormone-releasing hormone (GHRH) provocative tests (1 microg per rat, intravenously) showed the more significant elevation of growth hormone IGH) secretion in the arginine supplement group than that of glycine supplement group at 5 minutes (P < .05). There were no significant differences between basal levels of plasma rat GH in both groups. It is suggested that arginine has a possible significant role of GH secretion and intestinal mucosal growth after massive small bowel resection.
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Jun 26, 2014