A diurnal variation in urine urea excretion has been documented to exist in healthy young adults. Its persistence when dietary nitrogen intake approaches zero suggests that influences other than diet may in part generate the rhythm. These may include variations in the efficiency of rates of endogenous protein turnover or perhaps changes in renal tubular handling of urea especially in states of dietary nitrogen inadequacy. Recognition of these effects in the normal state are important before ascribing importance to changes in the disease state, particularly as we gain the ability to intervene nutritionally in the hospital setting.
Get full access to this article
View all access options for this article.
References
1.
Addis T., Drury DR: The rate of urea excretion. VII. The effect of various other factors than blood urea concentration on the rate of urea excretion. J Biol Chem55:629-638, 1923
2.
Campbell JA, Webster TA: Note on urinary tides and excretory rhythm. Biochem J16:507-513, 1922
3.
Campbell JA, Webster TA: Day and night urine during complete rest, laboratory routine, light muscular work, and oxygen administration. Biochem J15:660-664, 1922
4.
Simpson GE: Changes in the composition of urine brought about by sleep and other factors . J Biol Chem84:393-411, 1929
5.
Wesson LG: Electrolyte excretion in relation to diurnal cycles of renal function . Medicine43:547-592, 1964
6.
Walser M., Bodenlos LJ: Urea metabolism in man. J Clin Invest38: 1617-1626, 1959
7.
Wrong O.: The metabolism of urea and ammonia in the healthy and uremic colon . Med J Austral2:281-283, 1967
8.
Jones EA, Smallwood RA, Craigie A.: The enterohepatic circulation of urea nitrogen. Clin Sci37:825-836, 1969
9.
Giordano C., Phillips ME, DaPascale C. et al: Utilization of ketoacid analogues of valine and phenylalanine in health and uraemia. Lancet1:178-182, 1972
10.
Waterlow JC , Stephen JML: The effect of low protein diets on the turnover rates of serum, liver and muscle proteins in the rat, measured by continuous infusion of L(14C)lysine. Clin Sci35 :287-305, 1968
11.
Steffee WP, Goldsmith RS, Pencharz PB et al: Dietary protein intake and dynamic aspects of whole body nitrogen metabolism in adult humans. Metabolism25:281-297, 1976
12.
Picou D., Taylor-Roberts T.: The measurement of total protein synthesis and catabolism and nitrogen turnover in infants in different nutritional states and receiving different amounts of dietary protein. Clin Sci36:283-296, 1969
13.
Young VR, Steffee WP, Pencharz PB et al: Total human body synthesis in relation to protein requirements at various ages, Nature253:192-194, 1975
14.
Hinton P., Allison SP, Littlejohn S. et al: Insulin and glucose to reduce catabolic response to injury in burned patients. Lancet1: 767-769, 1971
15.
Munro HN: General aspects of the regulation of protein metabolism by diet and by hormones . IN Mammalian Protein Metabolism, vol 1, HN Munro, JB Allison (eds). Academic Press, New York , 1964, pp 381-481
16.
Rudman D., DiFulco TJ, Galambos JT et al: Maximal rates of excretion and synthesis of urea in normal and cirrhotic subjects. J Clin Invest52:2241-2249, 1973
17.
Rafoth RJ, Oustad GR: Urea synthesis after oral protein ingestion in man. J Clin Invest56:1170-1174, 1975
18.
Bistrian BRA simple technique to estimate severity of stress . Surg Gynecol Obstet148:675-678, 1979
19.
Technicon Instruments Corp: Technicon Autoanalyzer Methodology . Technicon Instruments Corp, Tarrytown , New York, 1969
20.
Munro HN, Fleck A.: Analysis of tissues and body fluids for nitrogenous constiuents. IN Mammalian Protein Metabolism, vol III, HN Munro (ed.), Academic Press, New York, 1969, pp 423-525
21.
Snedecor GW, Cochran WG: Statistical Methods, 6th ed. Iowa State University Press, Ames, Iowa, 1967
22.
Scrimshaw NS , Hussein MA, Murray E., et al: Protein requirements of man: variation in obligatory urinary and fecal nitrogen losses in young men. J Nutr102:1595-1604, 1972
23.
Pullman TN, Alving AS, Dern RJ, et al: The influence of dietary protein intake on specific renal functions in normal man. J Lab Clin Med44:320-332, 1954
24.
Turner WT, Cohn S.: Total body potassium and 24-hour creatinine excretion in healthy males . Clin Pharmacol Therapeut18:405-412, 1975
25.
Addis T., Barrett E., Poo LJ, et al: The relation between protein consumption and diurnal variations of endogenous creatinine clearance in normal individuals. J Clin Invest30:206-209, 1951
26.
Sirota JH, Baldwin DS, Villarreal H.: Diurnal variations of renal function in man. J Clin Invest29:187-192, 1950
27.
Best WR, Kuhl WJ, Friedemann TE: Diurnal trend and variation of urinary creatinine excretion. Fed Proc11:188, 1952 (Abstr)
28.
Curtis G., Fogel M.: Creatinine excretion: diurnal variation and variability of whole and part-day measures. Psychosom Med32: 337-350, 1970
29.
Addis T., Barrett E., Poo LJ, et al: The relation between the serum urea concentration and the protein consumption of normal individuals. J Clin Invest26:869-874, 1947
30.
Taylor YSM , Scrimshaw NS, Young VR: The relationship between serum urea levels and dietary nitrogen utilization in young men. Br J Nutr32:407-411, 1974
31.
VanSlyke DD : The effect of urine volume on urea excretion . J Clin Invest26:1159-1167, 1947
32.
Austin JH, Stillman E., VanSlyke DD: Factors governing the excretion rate of urea. J Biol Chem46:91-112, 1921
33.
Anderson CF , Jaecks DM, Ballon HS, et al: Renal handling of creatinine in nephrotic and non-nephrotic patients. Clin Sci38:555-562, 1970
34.
Elwyn DH, Hamendra CP, Shoemaker WC: Amino acid movements between gut, liver, and periphery in unanesthetized dogs . Am J Physiol215:1260-1275, 1968
35.
Schimke RT: Studies on factors effecting the levels of urea cycle enzyme in rat liver . J Biol Chem238:1012-1018, 1963
36.
Wurtman, R.Diurnal rhythm in mammalian protein metabolism. IN Mammalian Protein Metabolism, vol IV, HN Munro (ed). Academic Press, New York, 1970, pp 445-579
37.
Cahill GF Jr: Physiology of insulin in man. Diabetes20:785-799, 1971
38.
Schimke RT: Differentiated effects of fasting and protein free diets on levels of urea cycle enzymes in rat liver. J Biol Chem237:1921-1924, 1962
39.
Orth DN, Island DP, Liddle GW: Experimental alteration of the circadian rhythm in plasma cortisol (17-OHCS) concentration in man. J Clin Endocrinol27:548-555, 1967
40.
Munro HN: Free amino acid pools and their role in regulation. IN Mammalian Protein Metabolism, vol IV, HN Munro (ed). Academic Press, New York, 1970, pp 299-386
41.
Snyderman SE : Unessential nitrogen: a limiting factor for human growth. J Nutr78:57-72, 1962
42.
Schmidt-Nielsen B.: Urea excretion in mammals. Physiol Rev38: 139-168, 1958
43.
Rabinowitz L., Gunthor RA, Shoji ES, et al: Effects of high and low protein diets on sheep renal function and metabolism. Kidney Internat4:188-207, 1973
44.
Lassiter WE: Urea transport in the mammalian nephron. IN Urea and the Kidney , B Schmidt-Nielsen, DWS Kerr (eds). Excerpta Medica, Amsterdam, 1970
45.
Clapp JR: Renal tubular reabsorption of urea in normal and protein depleted rats. Amer J Physiol210:1304-1308, 1966
46.
Danielson RA , Schmidt-Nielsen B., Hohberger C.: Micropuncture study of the regulation of urea excretion by the collecting ducts in rats on high and low protein intakes . IN Urea and the Kidney, B Schmidt-Nielsen, DWS Kerr (eds). Excerpta Medica, Amsterdam, 1970
47.
Knepper MA, Danielson RA, Saidel GM, et al: Effects of dietary protein restriction and glucocorticoid administration on urea excretion in rats. Kidney Internat8:303-315, 1975
48.
Goldberg M. , Wojtczak AM, Ramirez MA: Uphill transport of urea in the dog kidney: effects of certain inhibitors. J Clin Invest46:388-399, 1967
49.
Truniger B. , Schmidt-Neilsen B.: Intrarenal distribution of urea and related compounds, effects of nitrogen intake. Am J Physiol207: 971-978, 1964
50.
Murdaugh HV Jr, Schmidt-Nielsen B., Doyle EM, et al: Renal tubular regulation of urea excretion in man. J Appl Physiol13:263-268, 1958
51.
Epstein FH, Kleeman CR, Pursel S., et al: The effect of feeding protein and urea on the renal concentrating process. J Clin Invest36:635-641, 1957
