Protective effects of vitamin e and probucol against gentamicin-induced nephrotoxicity in rats

Gentamicin (GM) is widely used as a bactericidal agent for the treatment of severe gram negative infections, however, its clinical use is partially limited due to its nephrotoxicity. Recent evidence suggests a role of reactive oxygen metabolites in GM nephrotoxicity. The present study was designed to investigate a possible potential protective role of vitamin E and/or probucol against GM nephrotoxicity. GM was administered to rats in a single dose of (150 mg kg(-1)i.p.), while vitamin E (250 mg kg(-1)i.m.) and/or probucol (60 mg kg(-1)i.m.) were given once daily for 3 consecutive days prior to GM administration. GM-induced nephrotoxicity was evidenced by marked elevations in serum urea and creatinine levels, urinary activity of N-acetyl-beta- d -glucosaminidase (NAG) and gamma-glutamyl-transferase (gamma-GT). Also, GM caused significant increases in kidney content of malondialdehyde (MDA), and significant decreases in kidney content of reduced non-protein sulphydryls (NPSH) and superoxide dismutase (SOD) activity. Vitamin E pretreatment significantly lowered the elevated serum urea and creatinine levels, and urinary activity of NAG and gamma-GT. In addition, vitamin E ameliorated the rise in renal content of MDA and enhanced the renal NPSH content as well as SOD activity. Similarly, probucol significantly inhibited the elevations in urea and creatinine levels and enhanced renal NPSH content and SOD activity. Simultaneous use of vitamin E and probucol was more effective in mitigating disturbances in the assessed parameters. The present work indicates that, due to their antioxidant activity, vitamin E and probucol have potential protective effects against GM nephrotoxicity.

Susceptibility of MT-null mice to chronic CdCl2-induced nephrotoxicity indicates that renal injury is not mediated by the CdMT complex

Chronic human exposure to Cd results in kidney injury. It has been proposed that nephrotoxicity produced by chronic Cd exposure is via the Cd-metallothionein complex (CdMT) and not by inorganic forms of Cd. If this hypothesis is correct, then MT-null mice, which cannot form CdMT, should not develop nephrotoxicity. Control and MT-null mice were injected s.c. with a wide range of CdCl2 doses, six times/week for up to 10 weeks, and their renal Cd burden, renal MT concentration, and nephrotoxicity were quantified. In control mice, renal Cd burden increased in a dose- and time-dependent manner, reaching as high as 140 microg Cd/g kidney, along with 150-fold increases in renal MT concentrations, reaching 800 microg MT/g kidney. In MT-null mice, renal Cd concentration (10 microg/g) was much lower, and renal MT was nonexistent. The maximum tolerated dose of Cd in MT-null mice was approximately one-eighth that of controls. MT-null mice were more susceptible than controls to Cd-induced renal injury, as evidenced by increased urinary excretion of protein, glucose, gamma-glutamyltransferase, and N-acetyl-beta-D-glucosaminidase, as well as by increased blood urea nitrogen levels. Kidneys of Cd-treated mice were enlarged and histopathology showed various types of lesions, including proximal tubular degeneration, apoptosis, atrophy, interstitial inflammation, and glomerular swelling. These lesions were more severe in MT-null than in control mice, mirroring the biochemical analyses. These data indicate that Cd-induced renal injury is not necessarily mediated through the CdMT complex and that MT is an important intracellular protein in protecting against chronic Cd nephrotoxicity.

Urinary excretion of proteins and tubular enzymes in renal transplant patients

The aim of this study was to evaluate, in renal transplant recipients with different function of the graft, the urinary excretion of some low molecular weight proteins and tubular enzymes frequently employed as indicators of tubular dysfunction. Urinary excretion of proteins and enzymes was measured in 51 renal transplant patients and, for comparison, in 73 patients affected by different kidney diseases with various degrees of renal function. Values of urinary beta 2-microglobulin and retinol-binding protein higher than normal were found in most transplanted patients, even in those with good renal function. On the other hand, in renal patients the urinary excretion of low molecular weight proteins was high only when creatinine clearance was lower than 30 mL/min/1.73 m2. Furthermore, an increased urinary excretion of tubular enzymes was found in a higher number of transplanted patients than of renal patients. This behavior was particularly evident for lysosomal enzyme N-acetyl-beta-D-glucosaminidase. In conclusion, a tubular dysfunction occurs in the transplanted kidneys, even in those with well preserved glomerular function.

The circadian variation of urinary N-acetyl-beta-D-glucosaminidase and gamma-glutamyl transpeptidase in clinically healthy cats

The circadian variation of urinary N-acetyl-beta-D-glucosaminidase (NAG, EC 3.2.1.30) and gamma-glutamyl transpeptidase (gamma-GTP, EC 2.3.2.2) was evaluated in cats. Urine and blood were collected at 4-hr intervals from adult cats (3 males, 9 females) weighing between 2.6 and 5.0 kg. There was no circadian variation in the urine volume, creatinine clearance, creatinine excretion, NAG excretion or gamma-GTP excretion. The average NAG and gamma-GTP indices in the 4-hr urine were similar to those for the 24-hr urine. However, the variance for the 4-hr urine samples was higher than that of 24-hr urine. In conclusion, although 4-hr urine samples can be used to estimate 24-hr urinary enzyme excretion, short-term spot urine samples may cause increased variation in the enzyme index.

Acute acetaminophen nephrotoxicity and urinary gamma-glutamyl transferase activity in rats

In order to determine the relationship between the nephrotoxicity of acetaminophen and urinary gamma-glutamyl transferase (GGT) excretion, a single dose of 900 mg/kg acetaminophen (APAP) was administered to rats intraperitoneally. Following drug administration, 24 hour urine was collected and the kidneys were removed under ether anesthesia for histological examination. GGT activity measurements and quantitative analysis for creatinine was carried out on urine samples. Urinary GGT activity in the APAP administered group (n = 12) (1.88 +/- 0.21 U/mg creatinine) was significantly higher than in the control group (n = 16) (0.77 +/- 0.05 U/mg creatinine) (p < 0.0002). Histological examination of the kidneys under light microscopy showed only very slight tissue damage. Further use of urinary GGT activity measurements in experimental nephrotoxicity studies has been suggested.

Chloracne and morbidity after dioxin exposure (preliminary results)

In this paper, 159 cases of chloracne contamination, reported from 1969 to 1975, in TCDD-contaminated production of the herbicide 2,4,5-trichlorophenol (2,4,5-T) were followed for mortality and morbidity up to 1996, when blood and urine tests were performed on 50 of these chemical workers ('exposed') and matched controls. In exposed workers, the most frequent cause of sick leave was chloracne, which persisted in 32%. Neurological symptoms were reported frequently (44% sleep disturbance, 32% headache, 30% neuralgia). BSR, leucocytes, gamma-GT, S-G0T and S-GPT were significantly higher than in controls. The effects of exposure (P = 0.002) and alcohol (P = 0.002) on gamma-GT were found to be independent of each other.

Changes of urinary enzyme activity after endoscopic treatment of vesico-ureteric reflux

The urinary enzymes Gamma Glutamyl Transferase (GGT), Alkaline Phosphatase (ALP), Leucine-Arylamidase (LAS), and Dipeptidyl-Peptidase-IV (DPP-IV) were measured before and after endoscopic treatment of vesico-ureteric reflux (VUR) in two groups of twenty children. Ten patients had undergone successful endoscopic corrective surgery for VUR, another 10 patients had unsuccessful endoscopic intervention. After successful treatment the activity of LAS in the urine did not change, but GGT, ALP and DPP-IV activity in the urine was 2-5 times higher than before treatment (P < 0.03 for all three enzymes). Considerable changes of urinary enzyme activity were not observed following unsuccessful endoscopic treatment. Our data and the literature are contradictory. However, this contradiction might be explained by the differences in urine sampling methods. Our patients received the same chemoprophylactic drug at the time of both urine samplings, a point not considered by other researchers. The extent of increase of enzyme activity after endoscopic treatment of VUR did not reach the level that would permit the use of investigated enzymes for screening, because the observed changes did not exceed the limits of the normal range.

Biotransformation, excretion, and nephrotoxicity of the hexachlorobutadiene metabolite (E)-N-acetyl-S-(1,2,3,4, 4-pentachlorobutadienyl)-L-cysteine sulfoxide

Hexachlorobuta-1,3-diene (HCBD) is nephrotoxic in rodents. Its toxicity is based upon a multistep bioactivation pathway. Conjugation with glutathione by glutathione S-transferases to form (E)-S-(1,2,3,4,4-pentachlorobutadienyl)-L-glutathione (PCBG), further processing to the corresponding cysteine S-conjugate, and finally processing to a reactive thioketene are thought to be responsible for the observed nephrotoxic effects. A novel metabolite, identified as (E)-N-acetyl-S-(1,2,3,4, 4-pentachlorobutadienyl)-L-cysteine sulfoxide (N-AcPCBC-SO), was described after administration of [14C]HCBD to male Wistar rats. This metabolite is formed by sulfoxidation of N-acetyl-S-(1,2,3,4, 4-pentachlorobutadienyl)-L-cysteine (N-AcPCBC) mediated by cytochrome P450 3A and has been found to be cytotoxic to proximal tubular cells in vitro without activation by beta-lyase. In rats, given HCBD in vivo, only one diastereomer of the sulfoxide is excreted; however, in rat hepatic microsomes two diastereomers, (R)- and (S)-N-AcPCBC-SO, are formed. This study focuses on the mechanisms responsible for this discrepancy and on a possible contribution of N-AcPCBC-SO to the nephrotoxicity of HCBD in vivo. (R,S)-N-AcPCBC-SO (1:1 mixture of both diastereomers) and N-acetyl-alpha-methyl-S-(1,2,3,4,4-pentachlorobutadienyl)-d, L-cysteine sulfoxide (alpha-Me-N-AcPCBC-SO) were administered iv to male and female Wistar rats (20, 40, and 80 micromol/kg of body weight). alpha-Me-N-AcPCBC-SO cannot be cleaved by cysteine conjugate beta-lyase even if alpha-Me-N-AcPCBC-SO is deacetylated by acylases. Excretion of gamma-glutamyltranspeptidase, protein, and glucose in the urine, indicative for kidney damage, and histopathological examination of the kidneys showed marked differences in the renal damage in male and female rats after application of N-AcPCBC-SO and alpha-Me-N-AcPCBC-SO. Necroses of the kidney tubules were only found in male, but not female, rats. Major sex-specific differences were observed in the elimination of sulfoxides; the (R)-isomer was excreted in a 5-10-fold excess to the (S)-isomer after application of (R,S)-N-AcPCBC-SO. After purification, both isomers were administered to male rats resulting in the urinary excretion of (R)-N-AcPCBC-SO after giving the (R)-isomer; treatment with (S)-N-AcPCBC-SO, however, revealed the formation of (S)-N-acetyl-S-(2-glycinylcystein-S-yl-1,3,4, 4-tetrachlorobutadienyl)-L-cysteine. The results show major sex-specific differences in the nephrotoxic potency of N-AcPCBC-SO and alpha-Me-N-AcPCBC-SO. However, both N-AcPCBC-SO and alpha-Me-N-AcPCBC-SO are nephrotoxic in males, suggesting the formation of a vinyl sulfoxide as an additional, beta-lyase-independent mechanism in HCBD-caused nephrotoxicity.

Lack of nephrotoxicity and renal cell proliferation following subchronic dermal application of a hydroquinone cream

Hydroquinone (HQ) is used in over-the-counter formulations of skin-lightening creams sold in the United States and European Union. HQ was introduced into these formulations to provide a safe and effective alternative to mercury and other less effective ingredients. Recent studies involving subchronic oral exposure of male F344 rats to HQ have shown nephrotoxicity and renal tubule cell proliferation (English et al., 1994), while chronic exposures of male F344 rats were reported to cause renal cell adenomas (NTP, 1989). Previous subchronic dermal toxicity studies (CTFA, 1986; NTP, 1989) with HQ failed to detect nephrotoxicity; however, these studies were not specifically designed to assess renal structure and function. More sensitive endpoints were used in the present subchronic study to address concerns over potential toxicity from repeated dermal exposure to HQ. Male and female F344 rats were given topical applications with 0, 2.0, 3.5, or 5.0% HQ in an oil-in-water emulsion cream for 13 wk (5 days/wk). Body weights, feed consumption and water consumption were monitored, and animals were observed for clinical signs of toxicity and dermal irritation. Blood taken at termination was analysed for haematological and clinical chemistry effects. Erythema, which abated when exposure stopped, was the only dermatological effect seen at the HQ-cream application sites. Cell proliferation in the kidneys was evaluated after 3, 6 and 13 wk of treatment using bromodeoxyuridine (BrdU) labelling, but no changes indicative of sustained cell proliferation were seen. The renal histopathological lesions noted after oral exposure to HQ were not present after dermal exposure. Thus, topical exposure to HQ does not result in the renal toxicity observed in previous studies with F344 rats given HQ orally.

[Changes in urinary enzyme activity following silicon therapy of vesico-ureteral reflux]

The urinary enzymes Gamma Glutamyl Transferase (GGT), Alkaline Phosphatase (ALP), Leucine-Arylamidase (LAS) and Dipeptidyl-Peptidase-IV (DPP-IV) were measured before and after endoscopic treatment of vesico-ureteric reflux (VUR) in two groups of twenty children's. Ten patients had undergone successful endoscopic corrective surgery for VUR, another 10 patients had unsuccessful endoscopic intervention. After successful treatment the activity of LAS in the urine did not change, but that of GGT, ALP and DDP-IV activity in the urine was 2-5 times higher than before treatment (P < 0.03 for all three enzymes). Considerable changes of urinary enzymes' activity were not observed following unsuccessful endoscopic treatment. Our data and the literature are contradictory. However this contradiction might be explained by the differences in urine sampling methods. Our patients received the same chemoprofilactic drug at the time of both urine sampling, a point not considered by other researchers. The extent of increase of enzyme activity after endoscopic treatment of VUR did not reach the level that would permit the use of investigated enzymes for screening, because the observed changes did not exceed the limits of the normal range.

Renal tolerance of digoxin-specific Fab fragments in the rat

Renal markers were investigated over 96 h in male Sprague-Dawley rats after i.v. administration of 10.7 mg kg(-1) of digoxin-specific Fab fragments (DSFab). The dose was calculated by an allometric equation as equivalent to a high clinical dose. DSFab both alone and pre-incubated with digoxin were tested. None of the markers (creatinine clearance, fractional excretion of sodium, urinary activities of gamma-glutamyl transferase and alkaline phosphatase) were significantly altered in treated rats compared to control rats. Thus no renal toxicity due to DSFab alone or bound to digoxin was observed when administered at 10.7 mg kg(-1) in rats.

Urinary excretion rates of multiple renal indicators after kidney transplantation: clinical significance for early graft outcome

Post-reperfusion inflammation as well as anti-allograft response occur following kidney transplantation. We evaluated tissue damage by multiple renal indicators and searched for rejection predictors forewarning serum creatinine upturns. Twenty recipients (43 +/- 9 y; donors' age 35 +/- 16 y) of first renal grafts were studied. All through their hospital stay (35 +/- 18 d, range 17-75 d) we measured serum levels of urea, creatinine and electrolytes along with urinary excretion rates of total protein, albumin, enzymes (GGT, NAG, AAP) and electrolytes. During the period of observation, peaks were seen on the 1st day for serum creatinine, serum K+ and urine albumin output; on the 2nd day for urine Na+, GGT, AAP and protein excretion rates; on the 4th day for urea and creatinine outputs; on the 5th day for NAG output. On the 14th day, serum urea and creatinine as well as urine GGT, NAG, AAP, albumin and total protein were still elevated compared to 20 healthy control subjects. Delayed/slow graft function was observed in six recipients with higher pre-transplantation plasma lipids and lower donor HDL cholesterol. Hospital stay time was correlated with need for post-transplantation dialysis (p = 0.01) and recipient proteinuria by time 0 (TO) to day 3 (p = 0.02). Cold ischemia time was positively associated with 0-3 d serum creatinine, 0-3 d urinary urea and protein outputs (multiple r 0.9, p < 0.001). Multivariate analysis of longitudinal data showed that recipients' serum creatinine was positively correlated (p < 0.001) with urine AAP and negatively correlated with urine albumin, with diuresis volume and urine creatinine (p < 0.01). Serum creatinine elevations were preceded (previous 1-7 d) by increases in urinary indicators, the probability being higher in the presence of multiple simultaneous abnormalities. Useful parameters predictive of favorable graft outcome prior to transplantation included a brief cold ischemia time and a normal donor/recipient serum lipoprotein profile. Following transplantation, useful parameters were a high diuresis volume at time zero along with low urine NAG and high albumin outputs; early (first opst-graft 3 d) polyuria, low urea and GGT, high K, NAG and total protein excretions.

Gamma-glutamyltransferase is a reliable marker for tubular effects of contrast media

The aim of this study was to evaluate the usefulness of the measurement of urinary excretion of the brush-border enzyme gamma glutamyl-transferase (GGT), in comparison with that of alanine aminopeptidase (AAP), as a marker for tubular toxicity due to contrast media (CM). Urinary activities of AAP and GGT were measured prior to the administration of CM and 1, 3 and 5 days after in forty-nine adult renal patients undergoing a radiological examination with intravascular administration of CM. The behavior of GGT was similar to that of AAP. In fact, urinary activities of both AAP and GGT increased greatly after CM. This effect was maximal on the 1st day and statistically significant for both enzymes. Furthermore, on the 1st day a relevant increase of enzyme activity (at least +50% over the basal value) was observed in the same number of patients (67%) for AAP and GGT. The concordance between GGT and AAP variations was high and statistically significant. Finally, different variables (osmolarity, dose of CM, and baseline renal function of the patients) had a similar effect on urinary excretion of AAP and GGT. The repeatability of duplicated determinations of GGT resulted better than that of AAP. In conclusion, the good concordance of the results of GGT with those of AAP justifies the use of GGT as a marker for tubular effects due to CM. Furthermore, the measurement of GGT has a better repeatability than that of AAP.

Biotransformation, excretion and nephrotoxicity of haloalkene-derived cysteine S-conjugates

The formation of cysteine S-conjugates is thought to play an important role in the nephrotoxicity of haloalkenes such as trichloroethene, tetrachloroethene and hexachlorobutadiene. Glutathione S-conjugates formed from these haloalkenes in the liver are processed to the corresponding cysteine S-conjugates, which may be N-acetylated to mercapturic acids and may be accumulated in the kidney. Haloalkene-derived cysteine S-conjugates are also substrates for cysteine conjugate beta-lyases and reactive intermediates are formed in this reaction. The equilibrium between cysteine S-conjugate and mercapturic acid thus influences the extent of beta-lyase dependent bioactivation and subsequently the nephrotoxicity of S-conjugates. In this study, we compared the rates of N-acetylation in vitro and the biotransformation, excretion and nephrotoxicity of S-(1,2-dichlorovinyl)-L-cysteine (1,2-DCVC), S-(2,2-dichlorovinyl)-L-cysteine (2,2-DCVC), S-(1,2,2-trichlorovinyl)-L-cysteine (TCVC) and S-(1,2,3,4,4-pentachlorobutadienyl)-L-cysteine (PCBC) in rats after i.v. injection (40 micromoles/kg). Marked differences in the extent of enzymatic N-acetylation were observed; N-acetylation was most efficient with 2,2-DCVC and least efficient with 1,2-DCVC. In urine, within 48 h, most of the given 2,2-DCVC (77% of the recovered dose) and 1,2-DCVC (92%) were recovered as the corresponding mercapturic acids. In contrast, a higher percentage of cysteine S-conjugate and less of the mercapturic acid were recovered in urine after administration of PCBC and TCVC (50 and 23% of dose as mercapturic acid), respectively. Histopathological examination of the kidneys and urine clinical chemistry showed marked differences in the extent of renal damage. Necroses of the proximal tubules were found after TCVC, PCBC and 1,2-DCVC administration in male, but not in female rats. These differences in nephrotoxicity do not correlate with the balance of acetylation/deacetylation. The higher toxicity observed in male rats may indicate the involvement of other parameters such as uptake mechanisms.

The measurement of renal injury

The classical assessment of nephrotoxicity by the measurement of serum urea nitrogen and creatine is insensitive and nonspecific. Selection from a battery of clinical pathology tests allows the sensitive and specific measurement of renal dysfunction and injury. This requires the collection of urine specimens of good technical quality, with appropriate preservation. Interaction of the test article with urinary enzymes should be evaluated prior to their measurement for the assessment of tubular injury. This enables the localization and quantification of the injury within the regions of the nephron. High resolution proton nuclear magnetic resonance spectroscopy, a technique for measurement of low molecular weight metabolites, shows great promise for the evaluation of renal tubular injury in toxicologic studies.

Urinary enzyme evaluation of nephrotoxicity in the dog

Over the past 20 yr, increased attention has been directed toward evaluation of urinary enzymes as markers of nephrotoxicity in dogs because the technique is noninvasive and considered to be more sensitive than the more commonly used conventional tests of renal function. Urinary enzymes also have the potential of determining the primary site of renal damage because different sections of the nephron have a characteristic complement of enzymes. In dogs, increases in brush border enzymes, including gamma-glutamyl transferase and alkaline phosphatase, have been associated with renal proximal tubular damage, while increases in N-acetyl-beta-D-glucosaminidase have been observed in the early stage of renal papillary necrosis. Urinary enzymes have been particularly useful in detection of acute renal damage in dogs, specifically tubular damage: however, their corresponding value in providing information about chronic renal damage remains to be established. Although elevation of certain enzymes appears to be a relatively sensitive measure of nephrotoxicity in the dog, there is no current agreement regarding which enzyme assays are the most appropriate for routine use in safety assessment studies. In addition, elevation of a single enzyme is of limited diagnostic value in detection of renal damage because spurious increases in urinary enzymes sometimes occur in normal dogs. Therefore, if one wishes to conduct special assessment of nephrotoxicity in dogs, evaluation of several enzymes at multiple time points is needed to compensate for normal enzyme variation and to identify potential anatomic site selectivity of the toxin.

Acute gentamicin-induced hypercalciuria and hypermagnesiuria in the rat: dose-response relationship and role of renal tubular injury

1. Standard renal clearance techniques were used to assess the dose-response relationship between acute gentamicin infusion and the magnitude of hypercalciuria and hypermagnesiuria in the anaesthetized Sprague-Dawley rat. Also investigated were whether these effects occurred independently of renal tubular cell injury. 2. Acute gentamicin infusion was associated with a significant hypercalciuria and hypermagnesiuria evident within 30 min of drug infusion. The magnitude of these responses was related to the dose of drug infused (0.14-1.12 mg kg(-1) min[-1]). Increased urinary electrolyte losses resulted from a decreased tubular reabsorption of calcium and magnesium. 3. A rapid dose-related increase in urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion was also observed in response to gentamicin infusion. However, there was no evidence of renal tubular cell injury and no myeloid bodies were observed within the lysosomes of the proximal tubular cells. Gentamicin may thus interfere with the mechanisms for cellular uptake and intracellular processing of NAG causing increased NAG release into the tubular lumen. 4. The absence of changes in renal cellular morphology indicates that the excessive renal losses of calcium and magnesium were an effect of gentamicin per se and not the result of underlying renal tubular injury. The renal effects described in this paper were apparent after administration of relatively low total drug doses, and with plasma concentrations calculated to be within the clinical range. These findings suggest that disturbances of plasma electrolyte homeostasis could occur in the absence of overt renal injury in patients receiving aminoglycoside antibiotics.

Urinary diagnostic indices in calves

OBJECTIVE

To establish reference values for urinary diagnostic indices in healthy calves from birth to 90 days of age.

DESIGN

Prospective field trial.

ANIMALS

12 Holstein heifer calves.

PROCEDURE

Urine and serum samples were collected daily for the first 5 days after birth, then weekly until calves were 90 days old. Urine:serum creatinine ratio, urine:serum urea nitrogen ratio, urine:serum osmolality ratio, fractional clearances of sodium and inorganic phosphate, and urine gamma-glutamyltransferase activity were measured. Data were grouped by age of calves at the time of sample collection: 1 to 5 days old (neonatal period), 7 to 27 days old (suckling period), and 28 to 90 days old (weanling period).

RESULTS

Mean urine:serum creatinine, urea nitrogen, and osmolality ratios were significantly higher during the weanling period than during the other 2 periods. There were no significant differences in mean fractional clearances of sodium among age periods.

CLINICAL IMPLICATIONS

Urinary diagnostic indices calculated for these healthy calves may be used as reference values for early recognition of renal damage or renal failure.

Renal tubular dysfunction in patients with inflammatory bowel disease treated with aminosalicylate

BACKGROUND

An increasing number of case reports indicate potential nephrotoxicity of 5-aminosalicylic acid (5-ASA), which shares similarities with the chemical structures of both phenacetin and acetylsalicylic acid.

AIM

In a point prevalence study the occurrence of sensitive indices indicative of early kidney malfunction was assessed in outpatients with inflammatory bowel disease.

METHODS

Routine indices of kidney function (creatinine clearance, urinary protein content, pH, electrolytes, and microscopy) were investigated in 223 patients with inflammatory bowel disease as well as sensitive markers of glomerular or tubular dysfunction (microproteinuria by SDS polyacrylamide gel electrophoresis (SDS-PAGE), urinary concentrations of N-acetyl-beta-D-glucosaminidase, alpha 1-microglobulin, gamma-glutamyltransferase (GGT), alkaline phosphatase (AP), and albumin). Histories of exposure to 5-ASA were assessed by questionnaire.

RESULTS

Patients receiving high amounts of 5-ASA, both actual as well as on a lifetime basis, showed an increased prevalence of tubular proteinuria by SDS-PAGE. Raised values for urinary AP and GGT indicate proximal tubular epithelial cells as the source. All other kidney function tests were normal. Analysis of covariates indicated strong associations between disease activity and size of 5-ASA doses as well as alterations in kidney tubular function.

CONCLUSION

The possibility exists that high doses of 5-ASA may be associated with proximal tubular proteinuria. This point prevalence study cannot dissect the possible impact of chronic inflammation from high dose 5-ASA treatment and further prospective studies are warranted.

The effect of neomycin on the kidney function of the horse

The toxic effect of neomycin on the horse kidney was studied. Twelve horses were used, and were divided at random into three groups of four. The first group was treated twice a day with 10 mg/kg I.M. for 15 days and then euthanised; kidney and liver samples were studied and no histopathological changes were observed. Group 2 was treated with neomycin sulphate as in group 1, and group 3 was used as control. Blood samples were taken at 8.00 h and 20.00 h daily from both neomycin treated and control horses. Serum creatinine, potassium, sodium and urinary creatinine remained without change. On day 6 of treatment plasma urea (Urea)p decreased to 5.6 +/- 2.0 mmol/L (P < 0.001) as compared with controls (8.0 +/- 2 mmol/L). Urinary excretion of GGT increased on the third day of treatment to 118.6 +/- 1 IU/L for treated and 89 +/- 8 IU/L for controls (P < 0.001). Thereafter, GGT continued to be elevated significantly for the duration of the experiment, as compared with controls. The (GGT)/(Cr)u ratio increased significantly on the 9th day of treatment, and continued to be elevated for 6 days after treatment. Neomycin kinetics were similar during treatment. It was concluded that neomycin, in the dose used, was not harmful to kidney function in the horse.

The effect of erythritol on the stability of gamma-glutamyl transpeptidase and N-acetyl glucosaminidase in human urine

In toxicology studies and clinical trials of erythritol, treated animals and human subjects had higher urine gamma-glutamyl transpeptidase [gamma-glutamyl transferase (gamma-GT)] than untreated controls. It has previously been reported that gamma-GT activity in frozen urine decreases with time; therefore, a study was undertaken to examine the effects of storage temperature, time, and the presence of erythritol on the stability of gamma-GT and N-acetyl glucosaminidase in human urine. In this study, it was found that the rate of decrease of the activity of gamma-GT is much greater at -20 degrees C than at -70 degrees C. Variation in the storage temperature of the frozen urine is particularly deleterious to gamma-GT. The addition of erythritol in a concentration of 5% reduces this decrease. Approximately 15% of N-acetyl glucosaminidase activity is lost in the initial process of freezing the urine. Thereafter, conditions of temperature, time, and the presence or absence of erythritol account for little additional loss of activity.

Betamipron reduces cisplatin nephrotoxicity in rodents without modifying its antileukemic activity in mice

Protective effects of betamipron (BP, N-benzoyl-beta-alanine), one of a series of N-acyl amino acids, on cisplatin-induced nephrotoxicity were examined. Since the damage observed in the kidney is localized to the proximal tubule cells, we investigated the influence of BP on urinary enzymes and excreta. Male Wistar rats and ddY mice were injected i.p. with 6 mg/kg and 16 mg/kg, respectively, of cisplatin combined with an i.p. 250 mg/kg BP dose. The toxicity of cisplatin as indicated by body weight gain, blood urea nitrogen, and serum creatinine levels was significantly (p < 0.05) suppressed by administration of BP after cisplatin treatment. The increase in urinary N-acetyl-beta-D-glucosaminidase activity, increase and subsequent decrease in gamma-glutamyl transferase activities, and increase in beta 2-microglobulin level observed after treatment with cisplatin were suppressed by administration of BP after cisplatin treatment. The combination of cisplatin and BP had no apparent effect on the efficacy of cisplatin against P388 leukemic cells in mice.

Age dependency of infradian rhythms in enzymuria of female volunteers

The enzyme excretion of dipeptidylpeptidase IV (EC 3.4.14.5), gamma-glutamyltransferase (EC 2.3.2.2), and alanine aminopeptidase (EC 3.4.11) was pursued in three different age groups of female volunteers over a period of 70 days. The first group (1-3 years: n = 6) consisted of girls living in a children's home, the second (26-50 years, n = 7) of medical staff and the third (65-87 years, n = 7) of the inhabitants of an old-age home. Subsequent to basic statistics the excretion patterns were analyzed by spectral analysis with the maximum entropy method. The mean values of all enzymes displayed a distinct age-dependency. The highest levels of enzyme excretion were found in the early childhood. In all groups infradian changes of enzyme excretion were detected. In excretion of gamma-glutamyltransferase, longer periods between 12 and 24 days predominated during the early childhood, whereas in the middle, and in particular in the higher age, shorter dominant periods occurred more frequently. The excretion of alanine aminopeptidase displayed a similar tendency. Circaseptan periods (7 +/- 1 days) were rarely observed among the dominant periods of the maximum entropy method spectra. A correlation analysis of the individual excretion patterns revealed that the excretion of all three bush-border enzymes is most tightly correlated in the early childhood (coefficients of correlation up to 0.9). In contrast, the correlation between enzymes and creatinine excretion was low in all age groups.