***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Persistent proteinuria is strongly associated with increased mortality in insulin dependent diabetes , and risk of this condition can be predicted many years in advance by sub clinical increases in albumin excretion rate ( microalbuminuria ) . Eight normotensive insulin dependent diabetics with microalbuminuria who had overnight albumin excretion rates of between 15 and 200 micrograms/min underwent a three week r and omised crossover study of their normal protein diet ( median 92 ( range 55 - 117 ) g/day )  and a low protein diet  ( 47 ( 38 - 57 ) g/day ) . Both diets were isoenergetic , and the low protein diet was supplemented with calcium and phosphate .  Median overnight albumin excretion rate fell from 23.0 ( 15.0 - 170.1 ) micrograms/min during the normal diet to 15.4 ( 4.1 - 97.8 ) micrograms/min during the low protein diet . No consistent change was found in urinary excretion of beta 2 microglobulin during the two diets . The reduction in albumin excretion rate was accompanied by a significant fall in median glomerular filtration rate and fractional renal clearance of albumin . Kidney volume remained unchanged . There were no significant changes in glycaemic control or arterial blood pressure . In these few patients restriction of dietary protein had a beneficial effect on microalbuminuria , independent of changes in glucose concentrations and arterial blood pressure Summary The influence of different protein intake on renal function was studied in 16 Type 1 ( insulin-dependent ) diabetic patients , aged 15–23 years , with onset of diabetes before puberty and with a duration of diabetes between 5 and 20 years .  The glomerular filtration rate , renal plasma flow , albumin excretion rate , and blood pressure were examined in a cross-over r and omised order after 10 days on isocaloric diets with either 10 % ( i.e. 0.9±0.06 g·kg−1·day−1 ) or 20 % ( 1.9±0.1 g·kg−1·day−1 ) of the calories as protein , the latter being equal to the recommended diet . Dietary compliance was evaluated using fractional phosphate excretion and overnight urea excretion . Glomerular filtration rate was lower after the low-protein diet compared to the usual protein diet ( p<0.001 ) . Patients  with glomerular filtration rate above + 2 SD of the normal mean on the usual protein diet ( n=6 ) exhibited the steepest fall in glomerular filtration rate with a mean decrease of 20ml/min compared to 7 ml/min in those with initially normal glomerular filtration ( p=0.01 ) . Filtration fraction tended to decrease on low protein diet , more so in initially hyperfiltering patients ( p=0.09 ) . Renal plasma flow remained unchanged . In patients with elevated glomerular filtration rate on usual protein diet , albumin excretion rate and systolic , but not diastolic blood pressure , were decreased on low protein diet ( p=0.03 and p=0.01 , respectively ) but not in initially normal-filtering patients . Mean blood glucose and serum fructosamine were unchanged on both diets . In conclusion , low protein diet decreases glomerular filtration rate independently of glycaemic control in young Type 1 diabetic patients and more so in hyperfiltering patients . This decline in glomerular filtration rate is accompanied by a decrease in albumin excretion rate and systolic blood pressure in hyper-filtering patients In a prospect i ve r and omised study of 228 patients with various renal diseases , early moderate dietary protein restriction  retarded the development of  end-stage renal failure . 149 patients were followed up for at least 18 months ; the protein-restricted patients showed falls in serum urea and phosphate concentrations and in the 24 h excretion of urea , phosphate , and protein . Regression analysis of the reciprocals of serum creatinine against time showed that the average rate of decrease in reciprocal creatinine was three to five times lower in the protein-restricted groups than in the control groups . These results confirm that moderate dietary protein restriction is an acceptable and effective way of delaying functional renal deterioration . The finding has implication s for the management of chronic renal insufficiency To assess whether moderate dietary protein restriction can delay the progression of overt diabetic nephropathy , 22 subjects with insulin-dependent diabetes mellitus were r and omly assigned to an unrestricted protein diet ( > 1.6 g.kg body wt-1.d-1 ) or a moderately protein-restricted diet ( 0.8 g.kg body wt-1.d-1 ) and followed prospect ively for six mo . Direct isotope methods were used to assess renal function . Protein intake was assessed by measurement of urinary urea nitrogen . The two groups were well-matched for age , sex , duration of diabetes , glycemic control , blood pressure , and degree of renal insufficiency . Patients consuming the unrestricted protein diet ( n = 11 ) showed a progressive decline in glomerular filtration rate of 1.3 mL.min-1.mo-1 with no change in proteinuria . Patients consuming the moderately protein-restricted diet showed a marked decrease in the degree of proteinuria ( 2.15 - 1.13 g/d , P = 0.036 ) and a stabilization of glomerular filtration rate . This occurred independently of changes in blood pressure or glycemic control . Moderate dietary protein restriction can ameliorate progression of overt diabetic nephropathy Proteinuria in diabetes is associated with progressive glomerular damage . We studied the effects of 3-wk dietary protein restriction on proteinuria and renal function in 10 insulin-dependent diabetic men with diabetic nephropathy . Patients were r and omly assigned by a crossover design to 40-g low-protein diet ( LPD ) or usual-protein diet ( UPD )  . Glomerular filtration rate and renal plasma flow were measured by inulin and p-aminohippurate clearance at the end of each period under conditions of sustained euglycemia . Total calorie intake , body weight , serum albumin and total protein concentrations , hematocrit , blood pressure , and glucose control were similar during the two diets . Achieved protein intake was 46 ± 3 g/day during LPD and 81 ± 4 g/day during UPD ( P < .001 ) . Urinary urea appearance and plasma urea were significantly lower on LPD . Median total urinary protein was reduced from 3.9 g/day ( range 0.5–12.3 ) on UPD to 2.4 ( range 0.2–9.0 ) on LPD ( P < .006 ) , and there was a significant fall in the median fractional clearance of albumin from 2.0 × 10−4 ( range 0.1–90.9 ) on UPD to 1.0 × 10−4 ( range 0.1–51.4 ) on LPD and IgG from 2.1 × 10−5 ( range 0.2–238 ) to 1.5 × 10−5 ( range 0.1–77 ) ( P < .006 and P < .02 , respectively ) . The reabsorption rate of β2-microglobulin was similar on the two diets and glomerular filtration rate , renal plasma flow , and filtration fraction remained unchanged . Thus , short-term dietary protein restriction reduces diabetic proteinuria independently of blood glucose or systemic blood pressure changes by improving glomerular permselectivity Diabetic nephropathy has become the leading cause of uremia . Several lines of evidence suggest dietary factors other than protein intake have a substantial role in the progression of diabetic nephropathy to end-stage renal disease . The present investigation was initiated to evaluate whether a carbohydrate-restricted , low-iron-available , polyphenol-enriched ( CR-LIPE ) diet may delay and improve the outcome of diabetic nephropathy to a greater extent than st and ard protein restriction . To this aim , 191 diabetic patients , all with type 2 diabetes , were r and omized to either CR-LIPE or st and ard protein restriction and the following outcomes monitored : doubling of serum creatinine , cumulative incidence of end-stage renal disease , and all cause mortality . Over a mean follow-up interval of 3.9 + /- 1.8 years , serum creatinine concentration doubled in 19 patients on CR-LIPE ( 21 % ) and in 31 control subjects ( 39 % ) ( P < 0.01 ) . Renal replacement therapy or death occurred in 18 patients on CR-LIPE ( 20 % ) and in 31 control subjects ( 39 % ) ( P < 0.01 ) . These differences were independent from follow-up interval , sex , mean arterial blood pressure , HbA(1c ) , initial renal dysfunction , and angiotensin system inhibitor use . In conclusion , CR-LIPE was 40 - 50 % more effective than st and ard protein restriction in improving renal and overall survival rates OBJECTIVE To determine , for individuals with type 2 diabetes and microalbuminuria , the effects of 6 weeks of meals containing plant-based protein ( PP ) versus meals with predominantly animal-based protein ( AP ) on renal function and secondarily on glycemia , lipid levels , and blood pressure . RESEARCH DESIGN AND METHODS In a r and omized crossover trial , we compared 6 weeks of meals containing only PP with meals containing primarily AP ( 60 % animal , 40 % plant ) in 17 subjects with type 2 diabetes and microalbuminuria treated with diet and /or oral antidiabetic agents .  Protein content was equivalent to the average American diet , and calories provided weight maintenance . Nutrients were equivalent between the two diets . Meals were prepared and packaged by a metabolic kitchen staff and were sent home weekly . At the beginning and end of each 6-week period , subjects were studied for 36 h on a metabolic unit . RESULTS There were no significant differences between diets for glomerular filtration rate , renal plasma flow , albumin excretion rate , total cholesterol , HDL cholesterol , triglyceride area under the curve ( AUC ) , glucose and insulin AUC , HbA(1c , ) blood pressure , or serum amino acids . For both diets , at the end of the treatment periods as compared with baseline , total cholesterol was significantly lower ( PP and AP : from 4.75 to 4.34 mmol/l , P < 0.01 ) , HbA(1c ) had significantly improved ( PP : from 8.1 to 7.5 % , P < 0.01 ; AP : from 7.9 to 7.4 % , P < 0.01 ) , and diastolic blood pressure was significantly lower ( PP : from 83 to 80 mmHg , P < 0.02 ; AP : from 82 to 78 , P < 0.02 ) . CONCLUSIONS There is no clear advantage for the recommendation of diets containing only PP rather than diets containing protein that is primarily animal-based for individuals with type 2 diabetes and microalbuminuria . There are , however , potential lipid , glycemic , and blood pressure benefits for following a carefully constructed , weight-maintaining , healthy diet , regardless of protein source OBJECTIVE To assess the effect of replacing red meat with chicken in the usual diet and the effect of a low-protein diet on glomerular filtration rate ( GFR ) , urinary albumin excretion rate ( UAER ) , and lipid levels in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A r and omized , crossover , controlled trial was conducted with 28 patients with type 2 diabetes ( seven women ; mean age 58.1 years ) : 15 patients were normoalbuminuric ( UAER < 20 microg/min ) , and 13 patients were microalbuminuric ( UAER 20 - 200 microg/min ) .  A chicken-based diet ( red meat replaced with chicken ) and a low-protein diet were compared with the patients ' usual diet . Patients followed each diet for 4 weeks with a 4-week washout period between . GFR ( (51)Cr-EDTA single-injection technique ) , 24-h UAER ( immunoturbidimetry ) , apolipoprotein B , total cholesterol , LDL cholesterol , HDL cholesterol , and triglycerides were measured after each diet . RESULTS Normoalbuminuric and microalbuminuric patients with diabetes were analyzed separately . In normoalbuminuric patients , GFR after the chicken ( 101.3 + /- 22.9 ml x min(-1 ) x 1.73 m(-2 ) ) and low-protein diets ( 93.8 + /- 20.5 ml x min(-1 ) x m(-2 ) ) was lower than after the usual diet ( 113.4 + /- 31.4 ml x min(-1 ) x 1.73 m(-2 ) ; P < 0.05 ) . In microalbuminuric patients , apolipoprotein B levels were lower after the chicken ( 113.5 + /- 36.0 mg/dl ) and low-protein diets ( 103 
    Output:
    
AUTHORS ' CONCLUSIONS The results show that reducing protein intake appears to slightly slow progression to renal failure but not statistically significantly so .
Because of the variability amongst patients , there might perhaps be a six month therapeutic trial of protein restriction in all individuals , with continuation only in those who responded best .