ÜRİNER SİSTEM TAŞ HASTALARINDA N-ASETİL-β-D- GLUKOZAMİNİDAZ DÜZEYLERİ ve MİKROALBUMİNÜRİ

Year 2008, Volume: 9 Issue: 3, 17 - 19, 01.12.2008

İzzet Koçak Çiğdem Yenisey Mehmet Dündar Mukadder Serter Ahmet Erinç Kandamar

Abstract

AMAÇ:Böbrek epitel hücrelerinin kristal oluşumu ile tubuler hasar ve/veya disfonksiyona yol açabilenetkileşimi pek çok çalışmada ortaya konmuştur. Bu çalışmanın amacı üriner sistem taşı hikâyesi olanlardaproksimal tübüler hasarın bir belirteci olan N-asetil-β-D-glukosaminidaz (NAG)'glomerüler bütünlüğün bir belirteci olan idrar mikroalbumin düzeylerini ortaya koymaktı.GEREÇ ve YÖNTEM:Çalışma grubunu, yakın zamanda spontan taş düşürme ve/veya girişimsel yöntemlerletaş tedavisi öyküsü olup metabolik değerlendirmeye alınan 23 (15 erkek ve 8 kadın) hasta oluşturdu. NAGdüzeyleri ticari kitler kullanılarak spektrofotometrik ve kolorimetrik metotla ölçüldü. Mikroalbuminüri analizikemiluminesans yöntemi ile değerlendirildi. Elde edilen sonuçlar benzer yaş gurubundaki 12 (5 kadın ve 7 erkek)sağlıklı kontrol ile karşılaştırıldı.BULGULAR:Çalışma ve kontrol grubu arasında serum ve idrar NAG düzeyleri (sırasıyla 11.86 ± 3.16 U/Lve10.82 ± 1.61 U/L ile 8.09 ± 2.84 U/L ve 6.34 ± 1.94 U/L) arasındaki fark istatiksel olarak anlamlı bulundu(p=0.01). Yine gruplar arasında mikroalbuminüri düzeyleri arasındaki fark da (17.71±3.95 µg/ml ve 7.18 ± 1.75µg/ml) istatiksel olarak anlamlı (p< 0.05) bulundu.SONUÇ:Çalışmamızın sonuçları üriner sistem taş hastalığının belirgin bir böbrek hasarı oluşturmasa bileglomerül ve tübül hücreleri üzerinde etkisi olabileceğini göstermektedir

Keywords

Üriner sistem taş hastalığı, NAG, mikroalbuminüri

N-acetyl-B-D-glucosaminidase Levels and Microalbumuniria in Patients with Urolithiasis

Abstract

OBJECTIVE: The interactions between renal epithelial cells and crystal formation leading to tubuler damage and/or dysfunction have been previously demonstrated in various studies. The aim of this study was to assess serum and urine levels of N-acetyl-B-D-glucosaminidase (NAG), a marker of proximal tubuler damage, and urinary levels of microalbumin, a marker of glomeruler integrity in patients with history of urolithiasis. MATERIAL and METHODS: The study group consisted of 23 metabolic evaluation patients (15 men and 8 women) who recently treated with urological interventions for urolithiasis and/or in patients with a history of spontaneous stone passage.NAGlevels were measured with spectrophotometric and colorimetric methods using commercial kits. Microalbuminuria was detected using chemiluminescence analysis. The results compared with levels of 12 (5 men and 7 women) healthy controls in same age group. RESULTS: The mean serum and urinaryNAGlevel were 11.86 ± 3.16 U/Land 10.82 ± 1.61 U/Lin patient group, respectively. In controls, the mean NAG level was 8.09 ± 2.84 U/L in serum and 6.34 ± 1.94 U/L in urine. The differences between the groups were statistically significant (p=0.01). There was also statistically significant difference in microalbumin levels between the study groups (17.71 ± 3.95 µg/ml and 7.18 ± 1.75 µg/ml), respectively (p< 0.05). CONCLUSION: The results of our study indicate that urolithiasis may have an influence on glomeruli and tubular cells even in the absence of apparent renal damage.

Keywords

Urolithiasis, NAG, microalbuminuria

References

• Khan SR. Hyperoxaluria-induced oxidative stress and antioksidants for renal protection. Urol Res 2005; 33: 349-57.
• Khan SR. Crystal-induced inflammation of the kidneys: results from human studies, animal models, and tissue culture studies. Clin Exp Nephrol 2004; 8: 75-88.
• Price RG: The role of NAG in the diagnosis of kidney disease including the monitoring of nephrotoxicity. Clin Nephrol 1992; 38: 14-9.
• Coca SG, Yalavarthy R, Concato J, Parikh CR. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int 2008; 73: 1008-16.
• Han WK, Waikar SS, Johnson A, Betensky RA, Dent CL, Devarajan P, Bonventre JV. Urinary biomarkers in the early diagnosis of acute kidney injury. Kidney Int 2008; 73: 863-9.
• Kösebalaban Ş, Ayyıldız A, Ayyıldız SN, Huri E. Vezikoüreteral reflüde (VUR) böbrek parankimal hasar göstergesi olarak idrarda N-Asetil-β-D- glukozaminidaz (NAG) seviyeleri.Türk Üroloji Dergisi 2004; 30: 187-93.
• Hostetter TH. Diabetic nephropathy. New Engl J Med 1985; 312: 642-4.
• Danziger J. Importance of low-grade albuminuria. Mayo Clin Proc 2008; 83: 806-12.
• Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. New England J Med 1984; 310: 356-60.
• Viberti GC, Hill RD, Jarret RJ, Argyropoulus A, Mahmud U, Keen H. Micoalbuminuria as apredictor of clinical nefrophaty in insulin-dependent diabetes mellitus. Lancet 1982; 26: 1430-2.
• Handa RK, Matlaga BR, Connors BA. Acute effects of percutaneous tract dilation on renal function and structure. J Endourol 2006; 20: 1030-40.
• Akdaş A, Turkeri LN, İlker Y. Short-term bioeffects of extracorporeal shockwave lithotripsy. J Endourol 1994; 8: 187-90.
• Thomas J, Arayon A, Arvis G. Microalbuminuria before and one month after extracorporeal lithotripsy. First results. J Urol 1993; 99: 81-5.
• Balla AA, Salah AM, Abdalmotaal E, Hoppe B, Bongartz D,Kessler T, Hesse A. N-acetyl -β-D- glucosaminidase excretion in healthy children and in pediatric patients with urolithiass. World J Urol 1998; 16: 413-6.
• Sikora P, Glatz S, Beck BB, Stapenhorst L, Zajackowska M, Hesse A, Hoppe B. Urinary NAG in children with urolithiasis, nephrocalcinosis, or risk of urolithiass. Pediatr Nephrol 2003; 18: 996-9.
• Huang HS, Chen J, Chen CF. Circulating adhesion molecules and neutral endopeptidase enzymuria in patients with urolitiass and hydronephrosis. Urology 2000; 55: 961-5.
• Baggio B, Gambaro G, Ossi E, Favaro S, Borsani A. Increased urinary excretion of renal enzymes in idiopatic calcium oxalate nephrolithiasis. J Urol 1983; 129: 1161-2. is. World J Urol 1998; YAZIŞMA ADRESİ
• Doç. Dr. İzzet KOÇAK
• Adnan Menderes Üniversitesi Tıp Fakültesi Üroloji AD, AYDIN E-Posta Telefon :[phone]
• Geliş Tarihi : 08.07. 2008
• Kabul Tarihi 31.12.2008 :