Low-protein diets in CKD: how can we achieve them? A narrative, pragmatic review

Low-protein diets (LPDs) have encountered various fortunes, and several questions remain open. No single study, including the famous Modification of Diet in Renal Disease, was conclusive and even if systematic reviews are in favour of protein restriction, at least in non-diabetic adults, implementation is lagging. LPDs are considered difficult, malnutrition is a threat and compliance is poor. LPDs have been reappraised in this era of reconsideration of dialysis indications and timing. The definition of a normal-adequate protein diet has shifted in the overall population from 1 to 1.2 to 0.8 g/kg/day. Vegan-vegetarian diets are increasingly widespread, thus setting the groundwork for easier integration of moderate protein restriction in Chronic Kidney Disease. There are four main moderately restricted LPDs (0.6 g/kg/day). Two of them require careful planning of quantity and quality of food: a â € traditionalâ €™ one, with mixed proteins that works on the quantity and quality of food and a vegan one, which integrates grains and legumes. Two further options may be seen as a way to simplify LPDs while being on the safe side for malnutrition: adding supplements of essential amino and keto acids (various doses) allows an easier shift from omnivorous to vegan diets, while protein-free food intake allows for an increase in calories. Very-low-protein diets (vLPDs: 0.3 g/kg/day) combine both approaches and usually require higher doses of supplements. Moderately restricted LPDs may be adapted to virtually any cuisine and should be tailored to the patients' preferences, while vLPDs usually require trained, compliant patients; a broader offer of diet options may lead to more widespread use of LPDs, without competition among the various schemas

Lymphomatous renal involvement

Leonard de Bona was a businessman, possibly of Italian descent, in Eagle Pass, Texas, who ran a hardware and supply store in that area for nearly 20 years. He served as a point of contact for customers throughout South Texas and nearby Mexico, providing not only hardware but food, clothing, and sundries. He had business contacts in San Antonio, Chicago, and abroad (Central Mexico, Italy, and other locations.)Archive of Correspondence relating to L. de Bona's Eagle Pass Hardware and Supply Store from 1887-1903 and undated. Approximately 500 letters, varying states of condition, some browning. An important archive for a businessman on the border in Eagle Pass, Texas with nearly 500 letters, most from neighboring Texas communities, order supplies.Organized by the following series: Correspondence and ChronologicalBona, L. de, Papers, 1887-1903 and undated, Southwest Collection/Special Collections Library, Texas Tech University, Lubbock, TexasOrder filled 1888-12-20