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Related Experiment Videos

Urinary enzymes in acute renal failure

S L Chew1, R L Lins, R Daelemans

  • 1Department of Nephrology-Hypertension, Algemeen Ziekenhuis Stuivenberg, Antwerp, Belgium.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|January 1, 1993
PubMed
Summary

Urinary N-acetyl-beta-glucosaminidase (NAG) and tissue non-specific alkaline phosphatase (TNAP) levels can help predict outcomes in acute renal failure (ARF). Elevated levels indicate a poorer prognosis in patients with ARF.

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Area of Science:

  • Nephrology
  • Biochemistry
  • Clinical Diagnostics

Background:

  • Intestinal-type alkaline phosphatase (IAP) is found in the S3 segment of renal tubules, a region susceptible to damage.
  • Acute renal failure (ARF) necessitates reliable diagnostic markers for prognosis.
  • Urinary enzyme levels may serve as indicators of renal injury and patient outcomes.

Purpose of the Study:

  • To evaluate the utility of urinary enzyme measurements in predicting outcomes for patients with acute renal failure (ARF).
  • To assess the diagnostic value of intestinal-type alkaline phosphatase (IAP), tissue non-specific alkaline phosphatase (TNAP), and N-acetyl-beta-glucosaminidase (NAG) in ARF.

Main Methods:

  • A pilot study prospectively followed 50 patients diagnosed with ARF over 17 months.
  • Urinary IAP, TNAP, and NAG levels were measured daily for 14 days using immunoassays and colorimetric assays.

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  • Patients were categorized into prerenal, renal, and postrenal groups, with renal ARF further classified into ATN, AIN, and AGN. Prognosis was divided into 'good' and 'poor' outcome groups.

    • Main Results:

    • Median urinary NAG concentrations at the start of evaluation were significantly higher in the 'poor' prognosis group (48.6 U/g creat) compared to the 'good' prognosis group (13.7 U/g creat, P < 0.01).
    • Median urinary TNAP concentrations were also significantly elevated in the 'poor' prognosis group (3.5 U/g creat) versus the 'good' prognosis group (0.9 U/g creat, P < 0.02).
    • While IAP levels showed a trend towards higher concentrations in the 'poor' prognosis group (3.2 vs. 2.2 U/g creat), this difference was not statistically significant (NS).

    Conclusions:

    • Urinary NAG and TNAP levels show promise as biomarkers for predicting patient prognosis in acute renal failure.
    • Elevated urinary concentrations of NAG and TNAP at the initial evaluation correlate with poorer outcomes in ARF patients.
    • Further research is warranted to validate these findings and explore the clinical application of these urinary enzyme markers in ARF management.