泌尿器科領域におけるNAG : ことに水腎症における意義について

Abstract

各種泌尿器科疾患を有する患者の尿中N-acetyl-β-D-glucosaminidase (NAG)活性値を測定した.1)前立腺肥大症, 前立腺癌, 膀胱腫瘍などでNAG高値は92.9%であった.ことに留置カテーテル例やIVUで一側腎盂腎杯像の描出不十分な例に異常高値をみた.2)腎結石, 尿管結石, 尿管皮膚瘻設置者と単腎者の尿中NAG活性値は全例異常高値で, とくに両側腎結石例やカテーテル留置中の尿管皮膚瘻設置者ではNAGは高値を示した.3)水腎・水尿管症と水腎症例の術前尿中NAG値は低値を示したが, 術後のNAG値は上昇した.尿中β2-microglobulinも同様の傾向を示した.4)これらの例の腎の病理組織学的と電子顕微鏡的所見では近位尿細管の変性, 萎縮や遠位尿細管の拡張と近位尿細管の上皮細胞内に多数のsecondaryとprimary lysosomeと認めた.以上より水腎症の尿中NAG低値は長期のobstructionによる尿中NAG放出障害を示唆し, 手術によるobstructionの解除が尿中NAG排泄を促進すると考えた

Activity of urinary N-acetyl-beta-D-glucosaminidase (NAG) has been studied in patients with urological diseases. In most patients with benign prostatic hyperplasia, prostate cancer and bladder cancer, activity of urinary NAG was elevated (92.9%), especially in cases of indwelling catheterization or poor visualization of IVU. Urinary NAGs were also elevated for all patients with renal stones, ureter stones, uretero-cutaneous stomy or a single kidney. In hydronephrosis or hydronephrosis with hydroureter patients, urinary NAG level was low pre-operatively, but increased post-operatively. Urinary beta 2-microglobulin (BMG) showed a similar tendency in patients with hydronephrosis or hydronephrosis with hydroureter. Electronmicroscopic observations of the kidney in such patients revealed many primary and secondary lysosomes.