[Selected biochemical parameters of urine in the evaluation of paracetamol nephrotoxicity].
A multitude of paracetamol synonyms, its common application in multidrug treatment, general availability contribute to frequent abuse of this drug. Recently observed increase in the number of suicide attempts with paracetamol is disturbing. Detailed clinical analysis of patients after intake of toxic doses of paracetamol revealed, apart from hepatotoxicity, cases of acute renal failure. Thus there is a need to search for sensitive indicators enabling early detection of nephrotoxic effects resulting from toxic doses of paracetamol.


METHODS
Material for research was urine and blood serum collected in a few successive days from 8 patients (6 female, 2 male) aged from 16 to 32 years old after single intake of paracetamol for suicidal purposes. The dose of taken paracetamol amounted on average to 17.8 gram. The control group consisted of 21 healthy individuals. Specific biochemical indicators marking proximal tubules were assessed--glutathione transferase-alpha (alpha-GST), distal tubular--glutathione transferase-pi (pi-GST), lysosomes: N-acetylbeta-D-glucosaminidase (NAG), iso-enzyme (NAG-B), beta-galactosidase (betaGAL), beta-glucuronidase (beta-Gr); brush border: alanine aminopeptidase (AAP), gamma-glutamyltransferase (GGT) as well as the efficiency of nephron resorption process through concentration of beta2-microglobulin (beta2M) in urine and its filtracy fraction of elimination. Moreover, the levels of free sialic acids, which in higher concentrations point to disturbances in glomerular filtration, were evaluated.


CONCLUSIONS
Acute kidney failure was found in none case. However, transient increase in NAG, NAG-B, alpha-GST, beta-Gr, GGT and beta2M enzymes was observed. On the basis of performed investigations it may be assumed that the determination of these parameters in urine will enable early detection of changes in the kidneys occurring under the influence of toxic doses of paracetamol and prevent their further development due to appropriate therapeutic management.
Marchewka
Zofia
Z
Katedra i Zakład Toksykologii, Akademii Medycznej we Wrocławiu. zomar@tox.am.wroc.pl
Przewłocki
Michał
M
Lepka
Magdalena
M
Długosz
Anna
A
Kochman
Krystyna
K
D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects*; D000118:Acetylglucosaminidase / Q000097:blood / Q000652:urine; D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D004305:Dose-Response Relationship, Drug; D005260:Female; D005982:Glutathione Transferase / Q000097:blood / Q000652:urine; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000201:enzymology; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000652:urine*; D007677:Kidney Function Tests; D007684:Kidney Tubules / Q000187:drug effects*; D008247:Lysosomes / Q000201:enzymology; D008297:Male; D013406:Suicide, Attempted / Q000517:prevention & control; D001613:beta 2-Microglobulin / Q000652:urine; D005723:gamma-Glutamyltransferase / Q000097:blood / Q000652:urine
D015415:Biomarkers; D001613:beta 2-Microglobulin; D000082:Acetaminophen; D005723:gamma-Glutamyltransferase; D005982:Glutathione Transferase; D000118:Acetylglucosaminidase