Korean Journal of Nephrology 1998;17(1):8-15.

Aminogllycosides계 항생제 유발 신손상시 조기 진단 지표로서의 요중 N - Acetyl - B - Glucosaminidase (NAG)활성도의 의의

김응석 , 김용섭 , 이정호

Abstract

Nephrotoxicity is a major factor limiting the cli- nical utility of aminoglycoside antibiotics(AG). In this study, we have therefore investigated the usefulness of the renal tubular protein for a pre- dictor of the nephrotoxicity of AG. We have also compared the nephrotoxicity among different AG. Among the simple fracture patients visiting orthopedics, for whom an AG seemed warrantable, we have sampled thirty-nine subjects--excluding those suffering from severe bleeding, taking drugs, or having renal disease which can affect the renal function. We have set three different groups by the following criteria,' ten subjects in group I were given 250mg of Amikacin sulfate twice a day, fifteen subjects in Groupll were given 60mg of Microno- micin sulfate twice a day, and fourteen subjects in GroupIII were given 200mg of Isepacin sulfate twice a day. Urine from each patient was collected for 24 hours before, one week after, and two weeks after the drugs were given, and then the urinary concentrations of NAG, 0 p-Microglobulin(8 z-MG), and electrolyte(Na', K', Cl ) were measured. The measurement of 24-hour urinary concen- trations of NAG shows that, for all three groups, significant increase of the concentrations(P<0.01) is seen between the different times in the same group. The results of measurements of the 24-hour urinary concentrations of z-MG, and electrolyteNa', Ke, Cl ) show their increase for all three groups but whithin the normal range. For the samples collected two weeks after the drugs were given, there is a significant decrease in the twenty-four-hour urinary concentrations of NAG(P<0.05) of Group III com- pared to Group I and II. The resulta of measure- ments of 24-urinary concentrations of 8 z-MG, and electrolyte(Na", K', Cl ) show their increase for all three groups but whithin the normal range. In conclusion, we have seen that the nephroto- xicity of the AG appears for all three groups', but, when we compare the nephrotoxicity between the different antibiotics, the nephrotoxicity of Amikacin sulfate and that of Micronomicin sulfate appear stronger than that of Isepacin suLfate. Our data sug- gest the usefulness of sequential NAG measurements in monitoring and predicting aminoglycoside nephro- toxicity.