While I agree that the baby's growth should be proof enough of the adequacy 
of its mother's milk, I don't think the doc who was treating the mother with 
the kidney disease was off base.  Normally our kidneys do not allow protein to 
enter our urine.  They filter out waste but conserve protein. Protein in urine is 
not normal.  Pregnant women with proteinuria have lower serum albumin levels 
than pregnant women with normal kidney function.  Low serum albumin 
predisposes to edema, also postpartum, and many of us have seen what an 
obstacle that can be to the normal establishment of breastfeeding.  Someone 
with low serum albumin will have great difficulty mobilizing edema fluid because 
they lack osmotic pressure to draw extracellular fluid into circulation.
In the case of the woman mentioned here on Lactnet, her kidney condition 
made her less able to tolerate a high protein diet, putting her doubly at risk for 
reduced serum protein.  She is losing protein because of her kidneys' inability 
to conserve it, and is less able to replenish her stores because of her 
compromised renal function.  She is also giving protein to her child via her 
milk.  Since blood is the substrate from which milk is synthesized, the level of 
protein in her milk could be a reasonable thing to wonder about.  Also, it may 
be that as long as she is lactating, she could tolerate a diet higher in protein 
since her breasts are actively removing protein from her blood with every 
feed.  
In any case, if her consumption (use) of protein is greater than her intake, her 
muscle mass could start to waste, OR she could become immune compromised 
herself due to lack of basic ingredients from which to synthesize her own 
immunoglobulins.  It sounds like a challenging case nutritionally. I say we 
should be relieved that her doctor is concerned enough to want to know more 
about it.
Rachel Myr
Kristiansand, Norway

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