Urinary NAG as an early indicator of renal damage in Russell's viper bite envenomation

Urinary N-acetyl-beta-D-glucosaminidase (NAG; beta-N-acetylglucosaminidase; EC 3.2.1.30), blood urea, serum creatinine and creatinine clearance were measured in 23 patients bitten by Russell's viper (Daboia russelii siamensis), with systemic envenomation, at different time intervals after the bite during clinical observation for 5 d. Activities of urinary NAG were compared with these indicators of renal function in 3 clinical conditions: non-oliguric acute renal failure (ARF), oliguric ARF not requiring peritoneal dialysis, and oliguric ARF requiring peritoneal dialysis. Cut-off values to identify the 3 conditions were established. When the times of onset of the conditions, indicated by the cut-off values, were compared, urinary NAG was generally found to be the earliest indicator of renal damage. In each type of ARF, the urinary NAG level was abnormal before changes in the values of the other indicators of renal function. It may be possible to predict the types of ARF within 2 h after the bite by measurement of urinary NAG.