JAMA. 1927;89(18):1518. doi:10.1001/jama.1927.02690180050015.
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The fact that protein and its derivatives are the only source of physiologically available nitrogen, together with the preeminence of the kidneys as the main organs for the excretion of nitrogenous waste products, has naturally led to the advocacy of a low protein diet in cases of renal insufficiency. A correlated tendency of comparatively recent appearance is the suggestion that structural injury to the kidney with its accompanying functional disturbance may result from the use of rations rich in this food principle. In some types of nephritis, protein is actually excreted in the urine—frequently in surprising quantities. It is a pertinent question in the dietary management whether to allow this loss to continue without attempting to overbalance it by raising the protein content of the ration or to risk further harm to the kidney tissue by attempting to maintain a positive nitrogen balance. On one hand, the albuminuria indicates a


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