経皮的腎切石術による腎機能の経時的変化--NAG-index,β2-microglobulinを指標として--

Abstract

尿中NAG-index, β2MGを指標とし術後腎機能の評価を行った.1) PNLでは術後腎機能は1ヵ月目までには術前値に回復し, 腎盂切石術が2ヵ月以上を要するのに比してより腎庇護的な術式である.2) PNLが3期以上にわたった例では腎機能回復が遅延する.3)水腎症高度例では尿中NAG (N-acetyl-β-D-glucosaminidase), β2MG排泄とも遅延する.4) β2MGを指標とすると見かけ上腎機能の回復は早期に起こるが, 同時点でNAG-indexは高値を示した.よってNAG-indexがより鋭敏に腎障害を反映しうる可能性があると考えられる.5)膀胱尿と腎瘻尿は術後5日以降はいずれも腎機能評価に関してはよい相関があり, 両者間に差を認めなかった.6) PNL後の腎機能測定はNAG-index, β2MGとも3日, 7日, 2週, 1ヵ月後にそれぞれ測定すれば術後腎機能回復の予測に有用である

To examine the influence of percutaneous nephrolithotomy (PNL) on renal function, we measured the activity of urinary N-acetyl-beta-D-glucosaminidase (NAG) and beta 2-microglobulin (beta 2MG) in patients with nephrolithiasis, before and 3, 5, 7, 14 days and 1 month after PNL. With PNL, renal function was recovered within one month, and PNL was thought to be a more protective method than pyelolithotomy. Recovery of renal function was delayed in the cases in which PNL had been attempted over three times. In the patients with preoperative high-grade hydronephrosis, the excretion of NAG and beta 2MG in the urine was delayed. NAG-index was considered to be a more sensitive parameter than beta 2MG to evaluate renal function. The NAG-index and beta 2MG values of bladder urine were in good correlation with those of nephrostomy urine 5 days or more postoperatively. Measurement of the urinary NAG-index 3, 7, 14, 30 days after PNL operation was considered valuable for determining changes in renal function.