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Increased urinary albumin excretion in children from families with Balkan nephropathy.

Balkan nephropathy (BN) has not been described in children. However, some previous studies have revealed abnormalities of the urinary tract in children from families with BN. In the present study, urinary excretion of albumin was studied in 703 healthy children, age 9-13 years, from endemic and non-endemic settlements around the South Morava River. Since BN is an environmentally induced disease, with possible seasonal variation of toxicant(s), children were studied three times a year: spring, autumn, and winter. After a water load of 15 ml/kg body weight, a 3-h urine sample was collected, from 7 to 10 a.m. Albumin excretion in urine was highest in children from families with BN in all three periods investigated. It was significantly different from excretion in children from the city, and in autumn it was also different ( P<0.01) from children in non-endemic families. Correlation analysis of albumin excretion with some urinary markers of tubular nephrotoxicity shows the highest correlation with both beta(2)-microglobulin and N-acetyl-beta-D-glucosaminidase in endemic villages in autumn. If the upper limit of albumin excretion is set at 8.5 mg/mmol creatinine, then in autumn increased albumin excretion was found in 15 of 229 children from endemic settlements and in only 5 of 454 children from non-endemic areas ( P<0.0001). Evidence is presented that in autumn children from families with BN excreted significantly more albumin than those from non-endemic families but living in the same settlements, or from children living outside of the endemic region in the city of Nis.

Acetylglucosaminidase↗

Simplified quantification of urinary protein excretion using a novel dipstick in children.

Although the quantification of protein excretion is valuable for diagnosing and monitoring renal disease, accurate, timed, urine collection entails practical difficulties in children. Several authors have shown that the random urine protein/creatinine ratio (UP/UC) correlates well with timed protein excretion. A novel dipstick, Multistix PRO, has recently enabled us to analyze concentrations of both urinary protein and creatinine, semi-quantitatively, in 60 s. The aim of this study was to investigate whether the UP/UC values obtained by Multistix PRO correlate well with those obtained by quantitative methods and daily urinary protein excretion. In order to obtain the UP/UC values, we measured urinary protein and creatinine concentrations both semi-quantitatively by Multistix PRO and quantitatively by conventional methods. The relationship between the semi-quantitative UP/UC by Multistix PRO and the quantitative UP/UC by conventional methods was analyzed. Similarly, the relationship between the semi-quantitative UP/UC and daily urinary protein excretion was studied. Semi-quantitative UP/UC by Multistix PRO correlated closely with both quantitative UP/UC and daily urinary protein excretion (r=0.86 and r=0.91, respectively). A cut-off level of heavy proteinuria, i.e., nephrotic range of proteinuria (>3.5 g/day) corresponded to 3.0, assessed by UP/UC by Multistix PRO. The semi-quantitative UP/UC by Multistix PRO correlated well with both quantitative UP/UC and daily urinary protein excretion, and use of the Multistix PRO would avoid errors and difficulties associated with timed urine collection. It is, therefore, a useful tool to monitor the urinary protein excretion in children with renal diseases at outpatient clinic.

Adolescent↗

Urinary excretion of urodilatin in healthy children and children with renal disease.

Urodilatin (URO) is a natriuretic peptide isolated from human urine which is thought to be produced by distal tubular cells. We measured urinary URO excretion in 50 healthy children and 23 children with acute (ARF), chronic renal failure (CRF), or hereditary tubular disorders, using a specific radioimmunoassay. The mean URO excreted in these four groups was 56, 45, 94, and 121 fmol/min per 1.73 m2, respectively (differences between first three groups not significant). The variation in URO excretion was larger in patients with kidney disease than in controls. There were significant correlations between urinary URO and sodium excretion in controls and CRF, but not in ARF. URO excretion also correlated with urine flow rate in CRF. Although no correlation was found between URO excretion and creatinine clearance, urinary URO was increased in some patients with advanced CRF, which suggests stimulated tubular production to compensate for reduced sodium excretion. In view of the therapeutic potential of URO in renal insufficiency, further study of the renal handling of URO is warranted.

Acute Kidney Injury↗

Creatinine excretion rates for renal clearance studies.

A total of 637 timed-urine collections for creatinine excretion rates obtained from 295 children over 14 years have been analyzed. The children ranged in age from 2.8 to 21.7 years at the time of the clearance study. The data analyzed included only one study from a child during any 6-month period. The objective is to provide data defining the expected range of creatinine excretion for renal clearance studies. One hundred forty-two studies were conducted on children not pretreated with cimetidine and 495 on those pretreated with cimetidine. Analysis showed that pretreatment with cimetidine for creatinine clearance studies does not alter creatinine excretion rates (P=0.080; 95% CI -0.03 to 1.61). Creatinine excretion rates in urine collections obtained at home (roughly 24-h collections) were compared with 2-h supervised collections in the Children's Kidney Center. The supervised urine collections resulted in creatinine excretion rates 1.38 mg/kg/24 h greater than home collections (P=0.001; 95% CI 0.76-2.00). Using regression equations for creatinine excretion rate with age, tables have been prepared showing the expected rate of creatinine excretion for renal clearance studies in children 3-21 years of age.

Adolescent↗

Effects of the angiotensin II type 1 receptor antagonist candesartan, compared with angiotensin-converting enzyme inhibitors, on the urinary excretion of albumin and type IV collagen in patients with diabetic nephropathy.

BACKGROUND: We previously reported that the angiotensin II type 1 receptor antagonist candesartan was effective in reducing blood pressure and microalbuminuria in hypertensive patients with diabetic nephropathy after angiotensin-converting enzyme (ACE) inhibitors were replaced due to side effects. In the present study, the clinical effects of candesartan were investigated and compared with ACE inhibitors in patients with stage 2 or 3A diabetic nephropathy, mainly with respect to the effects on the urinary excretion of albumin and type IV collagen. METHODS: Forty-nine patients (26 males/23 females) with diabetic nephropathy (stage 2 or 3A), including normotensive patients, were the study subjects. The patients were treated with either an ACE inhibitor (23 patients) or candesartan (26 patients) for 11 +/- 3 months. The urinary excretion of albumin and urinary type IV collagen was measured. RESULTS: Posttreatment blood pressure tended to decrease, but such a decrease did not reach a statistically significant level, nor did it show any intergroup difference. The urinary albumin excretion was positively correlated with pretreatment mean blood pressure and left ventricular mass index, but the urinary type IV collagen excretion did not show such correlations. The urinary albumin excretion decreased significantly after treatment to a similar extent in both groups, whereas the urinary type IV collagen excretion decreased significantly only in the candesartan group. CONCLUSION: It was revealed that ACE inhibitors and candesartan reduced urinary albumin excretion to a similar extent in patients with diabetic nephropathy. From the results of the present study, it is inferred that the renoprotective effect of candesartan in diabetic nephropathy may partially differ from that of ACE inhibitors.

Aged↗

Flux to acetate and lactate excretions in industrial fermentations: physiological and biochemical implications.

The efficiency of carbon conversion to biomass and desirable end products in industrial fermentations is diminished by the diversion of carbon to acetate and lactate excretions. In this study, the use of prototrophic and mutant strains of Escherichia coli, as well as enzyme active site directed inhibitors, revealed that flux to acetate excretion is physiologically advantageous to the organism as it facilitates a faster growth rate (mu) and permits growth to high cell densities. Moreover, the abolition of flux to acetate excretion was balanced by the excretion of lactate as well as 2-oxoglutarate, isocitrate and citrate, suggesting a 'bottle-neck' effect at the level of 2-oxoglutarate in the Krebs cycle. It is proposed that the acetate excreting enzymes, phosphotransacetylase and acetate kinase, constitute an anaplerotic loop or by-pass, the primary function of which is to replenish the Krebs cycle with reduced CoA, thus relieving the bottle-neck effect at the level of 2-oxoglutarate dehydrogenase. Furthermore, flux to lactate excretion plays a central role in regenerating proton gradient and maintaining the redox balance within the cell. The long-held view that flux to acetate and lactate excretions is merely a function of an 'over-flow' in central metabolism should, therefore, be re-evaluated.

Acetate Kinase↗

Biliary excretion of chenodeoxycholyllysylrhodamine in Wistar rats: a possible role of a bile acid as a carrier for drugs.

The effect on biliary excretion of rhodamine after its conjugation to give chenodeoxycholyl-lysyl-rhodamine (cheno-lys-R) was studied in male Wistar rats. Following its intravenous injection via the jugular vein of animals cheno-lys-R was efficiently excreted into bile with a peak biliary excretion of 31.6 +/- 1.2% dose 5 min-1 and a cumulative biliary excretion of 96.4 +/- 2.0% in 30 min of the total dose administered. Unlike cheno-lys-R, rhodamine had a poor biliary excretion of 1.0 +/- 0.1% dose 5 min-1 and a cumulative biliary excretion of 3.3 +/- 0.6% in 30 min. Cheno-lys-R had a short plasma half-life (t1/2 alpha) of 4.0 +/- 0.5 min, whereas free rhodamine had a longer half life (t1/2 alpha) of 82.1 +/- 1.4 min. The plasma clearances of cheno-lys-R and rhodamine were 41.2 +/- 6.5 and 9.0 +/- 1.2 ml/min per kg, respectively. The data indicate that the cationic fluorescent xenobiotic, rhodamine, when conjugated to the bile salt analogue, greatly increased the biliary excretion of rhodamine and that cheno-lys acted as a carrier for hepatic uptake of rhodamine. Thus, an appropriate bile salt derivative may be used to target a drug to the liver.

Animals↗

Effect of the glutathione-depleting agents diethylmaleate, phorone and buthionine sulfoximine on biliary copper excretion in rats.

The involvement of glutathione (GSH) in the biliary excretion of Cu was investigated in bile-cannulated inbred WAG/Rij and BN rats, pretreated with diethylmaleate (DEM), phorone or buthionine sulfoximine (BSO) and injected with Cu doses of 10 or 30 micrograms/100 g body wt. DEM reduced liver GSH to 27-56% and biliary GSH excretion to 18-38%; phorone reduced GSH in the liver to 55% and increased it in the bile (113%) followed by a slight decrease (79%); BSO reduced liver GSH to 50% and bile GSH to 20%. After injection of Cu to control rats a profile of biliary Cu excretion was found, composed of a slowly (SCuE) and a rapidly (RCuE) disappearing component, the latter only present after the dose of 30 micrograms Cu. DEM had no effect on SCuE after a 10 micrograms dose and a temporary effect on SCuE after a 30 micrograms dose in both WAG/Rij and BN rats. Phorone reduced SCuE after both Cu doses to 50%. Both agents abolished RCuE and reduced endogenous biliary Cu excretion to less than 50%. Release of injected Cu from plasma and uptake by the liver was inhibited by DEM and phorone in both rat strains; in BN rats basal plasma Cu level of DEM-treated rats was increased as well. BSO reduced SCuE after both Cu doses but had no influence on RCuE. Endogenous Cu excretion was reduced by BSO in BN rats but not in WAG/Rij rats. The results show that biliary Cu excretion proceeds by a pattern, the components of which can be affected differently by the various drugs. They also indicate that GSH is not directly involved in biliary Cu excretion but suggest that it may play a role in the metabolism of Cu in the liver.

Animals↗

A simple method for the correction of biliary excretion curves distorted by the biliary dead space.

Biliary solute concentrations measured at the tip of the cannula suffer a delay with respect to bile flow due to the transit time through the biliary tree volume. This study proposes a simple method, which is valid under variable bile flow conditions, to correct the distortion introduced by the biliary tree volume on the kinetic curves of the biliary excretion rate. The biliary transit time (tt) was calculated as the time needed to excrete a bile volume equal to the biliary tree volume by means of the interpolation of biliary cumulative volume versus time curves. Such tt permits one to estimate the canalicular concentration at time t, interpolating the biliary concentration curves at time t-tt. The product between the estimated canalicular concentration and the bile flow allows the calculation of the corrected biliary excretion rate. This method was evaluated by a comparison between biliary excretion rate curves of [14C]taurocholate [( 14C]TC) injected as a bolus under basal and sodium dehydrocholate (DHC)-induced choleresis conditions. Since the canalicular excretion rate of [14C]TC is considered independent of bile flow, the significant differences observed in its excretion kinetics under both conditions were attributed to distortion due to the biliary tree volume. After the correction, both curves showed a significant overlapping. This result indicates that the method improves the time-course representation of canalicular events in biliary excretion kinetic studies.

Animals↗

Effect of lysosomotropic agents on the taurocholate-stimulated biliary excretion of horseradish peroxidase.

The effects of the lysosomotropic agents chloroquine and leupeptin on the taurocholate-stimulated biliary excretion of horseradish peroxidase (HRP) was studied in bile fistula rats. HRP (0.5 mg/100 g body wt) was injected into the portal vein during taurocholate (0.4 mumol/min/100 g body wt) or saline infusion. HRP appeared in bile showing both an early (approx. 5 min) and a late (approx. 25 min) excretion peak. The late peak, which represented about 95% of the total HRP excreted, is due to transcellular vesicular transport. The early peak is mainly due to paracellular leakage although a rapid vesicular transport also contributes. Taurocholate infusion significantly increased the biliary output of HRP (both peaks) and of the endogenous lysosomal enzyme acid phosphatase. Pretreatment with chloroquine or leupeptin inhibited the taurocholate-stimulated late excretion of HRP into bile, without affecting its early excretion. The lysosomotropic agents did not affect the biliary excretion of bile salts but significantly inhibited the taurocholate-stimulated biliary excretion of acid phosphatase. The results are consistent with a role of lysosomes in the taurocholate-stimulated major transcellular vesicular transport of HRP into bile.

Acid Phosphatase↗

Enhanced biliary excretion of canalicular membrane enzymes in ethynylestradiol-induced cholestasis. Effects of ursodeoxycholic acid administration.

Cholestasis is associated with a marked increase in the release of canalicular membrane enzymes into bile. This phenomenon has been related to an increased lability of these canalicular membrane integral proteins to the solubilizing effects of secreted bile salts. To further characterize the effects of oral ursodeoxycholic acid (UDCA) administration on ethynylestradiol (EE)-induced cholestasis, the influence of this bile acid on changes in biliary excretion of membrane-bound enzymes was investigated. Bile flow, basal bile salt and biliary lipid secretory rates, the maximum secretory rate of taurocholate (TC SRm), and the biliary excretion of the canalicular membrane-bound ectoenzymes alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) were measured in rats after EE and/or UDCA administration. The activities of ALP, GGT and Na+,K(+)-ATPase in purified isolated canalicular and sinusoidal membrane fractions and the ultrastructure of hepatic acinus, including histochemical studies of ALP distribution, were also examined. EE significantly reduced bile flow, bile salt and biliary lipid secretory rates, and TC SRm, and caused dilatation and loss of microvilli at the canalicular pole of hepatocytes. Biliary excretion of ALP increased 2-fold, whereas biliary excretion of GGT was unchanged. The relationship between biliary excretion of ALP or GGT and bile salt secretion (units of enzyme activity secreted per nanomole of bile salt) was greater in EE-treated rats compared with controls (2.1- and 1.5-fold greater for ALP and GGT, respectively), indicating that in EE-induced cholestasis more enzyme was released into bile per nanomole of bile salt. Na+,K(+)-ATPase activity in sinusoidal membrane fraction was reduced significantly, whereas ALP activity increased in both membrane fractions in EE-treated rats. The histochemical distribution of ALP in the acinus showed a strong reaction in acinar zone 3 and at both the canalicular and sinusoidal membranes. Oral administration of UDCA prevented EE-induced bile secretory failure by normalizing bile flow, bile salt and biliary phospholipid secretory rates, and TC SRm. UDCA also prevented the EE-induced changes in the biliary excretion of enzymes. On the contrary, UDCA did not modify either the enzyme activity in isolated membrane fractions or the morphological or ALP histochemical changes associated with EE administration. These data indicate that in EE-induced cholestasis changes occur at the canalicular membrane, enabling this portion of the plasma membrane to be more susceptible to the solubilizing effect of bile salt, and that oral administration of UDCA prevents bile secretory failure and changes in the biliary excretion of ALP and GGT in EE-treated rats.

Alkaline Phosphatase↗

Urinary excretion of hydroxyproline, hydroxylysine and hydroxylysine glycosides by patients with Paget's disease of bone and carcinoma with metastases in bone.

Patient's with carcinoma metastases in bone and Pagent's disease of bone have different patterns of collagen metabolite excretion. Both forms of bone disease resulted in an increased excretion of total hydroxyproline and the ratio of glucosylgalactosylhydroxylsine to galactosylhydroxylysine was below normal. The excretion of glucosylgalactosylhydroxylysine and galactosylhydroxylysine was increased in all patients with carcinoma metastases in bone while the excretion of glucosylgalactosylhydroxylysine in patients with Paget's disease. The ratio of total hydroxylysine (free hydroxylysine + glycosylated hydroxylysines) to total hydroxyproline was normal in patients with carcinoma metastases in bone and below normal in patients with Paget's disease bosne. The pattern of urinary collagen metabolite excretion is a more specific indicator of the presence of bone disease than is the measurement of the excretion rate of any individual collagen metabolite. Bone diseases of different etiologies may result in different patterns of urinary collagen metabolite excretion.

Bone Neoplasms↗

Urinary excretion levels of unconjugated pterins in cancer patients and normal individuals.

Urinary excretion levels of seven unconjugated pterins in healthy individuals and in cancer patients, most of whom were undergoing chemotherapy, were measured utilizing a newly developed high-pressure liquid chromatographic system. Excretion of pterins in the control group appears to be under strict metabolic control as the values obtained were confined within a small range. When the mean excretion levels in control subjects were compared with those in cancer patients, we found a significant increase in the excretion of xanthopterin, neopterin and pterin and a significant decrease in isoxanthopterin by cancer patients. Biopterin levels, on the other hand, were found only slightly but not significantly increased, whereas pterin-6-carboxylic acid and 6-hydroxymethylpterin were found to be excreted in approximately equal amounts in both groups. Urinary excretion levels of pterins were monitored for a period of nine months in a patient being treated with chemotherapy for metastatic ovarian carcinomatosis. We found that the excretion pattern of pterins appeared to correlate with the clinical status of the patient. These results indicate that a definite imbalance in pterin, and possibly folate metabolism, is associated with the presence of malignant diseases.

Adult↗

Excretion of epidermal growth factor (EGF) in diabetes.

Excretion of epidermal growth factor (EGF) is decreased in renal failure. We assayed it in diabetes mellitus in an attempt to relate it to clinical parameters, esp. those of diabetic nephropathy. EGF excretion declined with age but in all age groups of diabetic patients was below the first percentile for controls. In 26 control and 34 prepubertal diabetic children excretion was correspondingly 1126 +/- 442 and 932 +/- 489 pmol/mmol creatinine (P = 0.087); in 26 control and 42 diabetic adolescents below age 18, 778 +/- 222 and 676 +/- 335 (P = 0.023) and in 81 control and 83 diabetic adults, 371 +/- 153 and 235 +/- 140 (P less than 0.0001). Decreased excretion of EGF was seen in some patients without any diabetic complications. Excretion of EGF was independently and inversely correlated with age and duration of diabetes but not with type of diabetes, treatment, body built, C-peptide, plasma glucose, glycohemoglobin or retinopathy. A positive correlation was seen with creatinine clearance and a negative correlation, with albuminuria, but the strongest and the only independent correlation found by stepwise multiple variable selection was with serum creatinine (r -0.711, P less than 0.0001). EGF excretion was not elevated in patients with hyperfiltration. We conclude that EGF excretion is abnormal in many patients with diabetes and that this abnormality reflects a kidney function different from glomerular filtration or glomerular permeability.

Adolescent↗

Capillary gas chromatography as a tool for characterization of urinary steroid excretion in patients with congenital adrenal hyperplasia.

Urinary steroid excretion was studied by capillary gas chromatography in 23 patients with congenital adrenal hyperplasia. In 5 patients the estimated excretion rates of pregnanetriol were in or below the normal range and 7 patients presented supranormal excretion rates of tetrahydro-cortisone and/or other glucocorticoid metabolites. Deficiency of 21-hydroxylase was nevertheless demonstrated in each patient by an increased ratio of excreted precursors vs products of 21-hydroxylase, e.g. of pregnanetriol/tetrahydro-cortisone. Due to this relative deficiency of glucocorticoids the patients' steroid excretion was further characterized by a predominance of 5 alpha-hydrogenated C19O3 metabolites (11-keto-androsterone, 11-hydroxy-androsterone) over their 5 beta-hydrogenated homologues (11-keto-etiocholanolone, 11-hydroxy-etiocholanolone). An apparent preponderance in the excretion of pregnenetriol over that of pregnanetriol was found in 4 patients, but the presence of pregnenetriol was not confirmed by mass spectrometry following prepurification of the urine samples by thin-layer chromatography indicating interference of an unidentified steroid metabolite with the initial gas chromatographic analysis. The simultaneous determination of steroids serving as precursors or products of 21-hydroxylase by capillary gas chromatography helps to establish the diagnosis of 21-hydroxylase deficiency and to characterize the pattern of steroid excretion in this syndrome even in patients where the estimation of single urinary steroids may lead to erroneous conclusions.

Adolescent↗

Urinary excretion of carnitine in patients with hyperthyroidism and hypothyroidism: augmentation by thyroid hormone.

Urinary excretion of carnitine and serum concentrations of carnitine, triglyceride, and free fatty acids were measured in 54 hyperthyroid and 13 hypothyroid patients, and the results were compared with those of normal subjects. In hyperthyroid patients urinary excretion of carnitine was highly increased above that of the control subjects. On adequate treatment with antithyroid drug, carnitine excretion was reduced to the normal range, and serum lipids changed in parallel. In contrast, carnitine excretion was markedly reduced in hypothyroid patients. After substitution therapy with thyroid hormones the excretion increased in these patients. This change was associated with a marked reduction of serum triglyceride. There was an inverse correlation between urinary excretion of carnitine and serum triglyceride concentration. Carnitine excretion was significantly correlated with serum thyroxine concentration in hyper- and hypothyroid patients. The results suggest that thyroid hormones play an important role in carnitine metabolism, which in turn influences serum triglyceride metabolism.

Adolescent↗

Increase of lipoprotein-lipase activity in skeletal muscle during heavy exercise. Relation to epinephrine excretion.

As part of the training programme for Swedish elite soldiers, a 10 day march is carried out with a heavy pack under active-service conditions. Six soldiers volunteered to take part in an investigation on the energy consumption with special regard to the lipid metabolism at different levels of physical effort. The degree of physical work was evaluated by continuous heart-rate recording and analysis of the excretion of epinephrine and norepinephrine in the urine. Fasting values of triglycerides and free fatty acids in blood plasma were determined and muscle biopsies (taken in the morning and in the afternoon) were analysed for lipoprotein-lipase (LPL) activity. After an overnight fast the free fatty acids were increased only in the mornings following days of heavy physical work. The plasma triglyceride concentrations were lowest in a morning proceeded by 3 days of heavy work. The muscle LPL activity in the morning was highest after a day of heavy work and lowest after days of rest. During days of heavy work this activity increased and was higher in the afternoon than in the morning. Muscle LPL activity in the afternoon was closely related to urinary excretion of epinephrine. The data indicate that LPL activity is elevated in the working skeletal muscle increasing the access of fatty acids. The degree of elevation is related to the degree of effort as described by the urinary excretion of morning. Muscle LPL activity in the afternoon was closely related to urinary excretion of epinephrine. The data indicate that LPL activity is elevated in the working skeletal muscle increasing the access of fatty acids. The degree of elevation is related to the degree of effort as described by the urinary excretion of morning. Muscle LPL activity in the afternoon was closely related to urinary excretion of epinephrine. The data indicate that LPL activity is elevated in the working skeletal muscle increasing the access of fatty acids. The degree of elevation is related to the degree of effort as described by the urinary excretion of epinephrine.

Catecholamines↗

Orotic acid excretion during starvation and refeeding in normal men.

The effects of acute food deprivation and subsequent refeeding on urinary orotic acid excretion were examined in nine healthy adult male subjects. During inpatient metabolic ward conditions, the volunteers were fed a nutritionally complete, pyrimidine- and purine-free diet for three days and subsequently underwent a ten-day fast followed by a ten-day period of refeeding by total parenteral nutrition. Mean daily excretion of 4.33 +/- 0.23 mg (2.77 +/- 0.12 mg/g creatinine) of orotic acid during the enterally fed state was significantly reduced (mean 46 +/- 5%) in all subjects during starvation. This reduction in the excretion of orotic acid during starvation is more likely related to a lowered rate of production and utilization. The starvation adaptation of orotate excretion occurred more rapidly than did the decrease in urinary nitrogen loss. All subjects showed an increase (mean 48 +/- 14%) in the excretion of orotic acid during the first day of refeeding which continued throughout the refeeding phase. A significant positive correlation was shown between the daily orotic acid excretion and nitrogen intake (r = 0.98) or protein balance (r = 0.83). The response to refeeding of acutely malnourished normal male is an increase in orotic acid excretion with a decrease in whole body protein catabolism.

Adult↗