Kidney Res Clin Pract 2019 Jun; 38(2): 205-211  
Serum alkaline phosphatase and γ-glutamyl transferase in acute pyelonephritis
Chaehoon Han1 , Young-Ki Lee1 , Hayne Cho Park1 , Ajin Cho1 , Sun Ryoung Choi1 , Jong-Woo Yoon1 , Ja Ryong Koo1 , Hyung Jik Kim1 , Jung-Woo Noh1 , Min-Jeong Park2
1Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
2Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
Correspondence to: Young-Ki Lee
Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea. E-mail: km2071@naver.com
Received: July 9, 2018; Revised: December 13, 2018; Accepted: January 7, 2019; Published online: June 30, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Elevated serum alkaline phosphatase (AP) and γ-glutamyl transferase (γ-GT) are commonly observed in patients with acute pyelonephritis. The goal of this study was to examine the clinical significance of elevated serum AP and γ-GT levels and to explore the mechanisms underlying these changes.
Methods: We examined serum AP and γ-GT levels in 438 patients with acute pyelonephritis. Urine AP/creatinine (Cr), urine γ-GT/Cr, fractional excretion of AP, and fractional excretion of γ-GT (FEγ-GT) were evaluated in patients with elevated and normal serum levels. AP isoenzymes were also examined.
Results: We identified 77 patients (17.6%) with elevated serum AP and 134 patients (30.6%) with elevated serum γ-GT. Among them, both enzymes were elevated in 64 patients (14.6%). Older age, longer hospital stay, elevated baseline serum Cr, and complicated pyelonephritis were associated with increases in serum AP and γ-GT. Multivariate analysis showed that high serum AP levels were significantly correlated with renal impairment (odds ratio, 2.13; 95% confidence interval, 1.08–4.19; P = 0.029). FEγ-GT was significantly lower in patients with elevated serum enzyme levels. The liver fraction for AP isoenzyme profile did not increase in patients with elevated serum AP.
Conclusion: Our results demonstrated that elevated serum AP and γ-GT levels are associated with complicated pyelonephritis and renal impairment. Lower FEγ-GT levels in patients with elevated serum enzymes may be the result of decreased urinary excretion of these enzymes.
Keywords: Alkaline phosphatase, gamma-Glutamyltransferase, Pyelonephritis


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