CDDP腎障害時における尿中β-GlucuronidaseおよびAlkaline phosphatase活性測定の意義について

Abstract

Cisdichlorodiamine platinum (CDDP)による腎障害において, 1)尿中β-GLおよびALPの1日あたりの総活性の正常値はそれぞれ, 5, 665±2.534 μg/day, 7.1±1.7 IU/dayであった.2)尿中β-GL活性はCDDP投与により尿中NAG活性とある程度一致して変動するが, 尿路悪性腫瘍や上部尿路感染を合併している症例では高値を示す場合があり, 泌尿器科領域においてはCDDPによる尿細管障害の指標としての意義は少ない.3)尿中ALPは尿中γ-GTPと同様の活性変動を示し, CDDPによる尿細管障害のマーカーとしての尿中ALPは有用である

Renal toxicity is the major side effect of cis-dichlorodiammine platinum (CDDP) and it develops renal tubular damage. In the present study, the acute changes of urinary beta-glucuronidase (beta-GL) and alkaline phosphatase (ALP) activities following CDDP administration as indicators of its toxicity were studied in 5 patients with urological malignant tumors. The activities were measured for 11 days continuously from the day before CDDP administration. In all cases, both urinary enzyme activities increased with CDDP administration. Increase patterns of urinary beta-GL activities were similar to those of urinary NAG, but remarkably-high values of beta-GL activities were found in cases of urothelial tumors probably because urinary beta-GL derives from the kidney (lysosomes of tubular cells) and from the epithelial cells of urinary tract. Urinary ALP activities changed corresponding well with urinary gamma-glutamyl transpeptidase (gamma-GTP). This study shows that the determination of urinary beta-GL is not a significant marker of CDDP renal toxicity, especially in cases with urological malignancies, in contrast to results for urinary brush border enzyme activities such as ALP or gamma-GTP.