Essential amino acids have been advocated as standard therapy for renal failure. Which of the following statements are true?

B. Essential amino acids retard the rise of blood urea nitrogen (BUN) secondary to decreased urea appearance.

D. Essential amino acids decrease BUN and creatinine to the same degree as solutions containing excessive nonessential amino acids

DISCUSSION: Essential amino acids and hypertonic dextrose, as opposed to hypertonic dextrose alone, was reported by Abel and co-workers to be associated with a decreased mortality rate in mostly surgical patients with acute tubular necrosis. The most significant improvement in mortality, as compared with the control group receiving hypertonic dextrose, was among patients who required dialysis (i.e., the more severely affected patients). Another group responding favorably to treatment includes patients with nonoliguric renal failure whose need for dialysis is not clearly established. The effect of essential amino acids in preventing a rise in BUN, as well as its beneficial effect in preventing hyperkalemia, may obviate dialysis in such patients. With increasing amounts of nonessential amino acids, BUN increases, and thus, dialysis is required. Prospective randomized studies comparing the use of essential versus nonessential amino acids in patients with acute renal failure have not been carried out in sufficient numbers to yield answers to this question.