Urinary biomarkers in assessing the nephrotoxic potential of gentamicin in solitary kidney patients after 7 days of therapy.
BACKGROUND
The solitary kidney (SK) may present increased vulnerability to nephrotoxicity because of adaptive phenomena.


OBJECTIVE
Assessing the vulnerability of the SK with urinary tract infections (UTI) to gentamicin by means of urinary biomarkers (N-acetyl-beta-D-glucosaminidase (NAG) and urinary alpha-1-microglobulin), as well as glomerular filtration rate (GFR).


METHODS
We studied 14 patients with SK with UTI (group A) (mean age 58.07 ± 13.61 years, mean duration of SK 13.55 ± 12.33 years) who were administered gentamicin for 7 days. Group B consisted by 17 patients with SK without any other associated renal pathology (average age 51.17 ± 9.39 years, average existence period of a single kidney 33.23 ± 21.73 years). We also included a third group (group C) represented by nine healthy individuals, with two kidneys.


RESULTS
Increased values of urinary NAG were found in group B as compared to group C and alpha-1 microglobulin in group A as compared to group B. During treatment with gentamicin, increased values of both NAG and alpha-1-microglobulin in group A were found on day 7 as compared to values before treatment (day 7 NAG=18.99 ± 14.07 U/g creat versus day 0, NAG=5.15 ± 6.54 U/g creat, p=0.004; day 7 alpha-1-microglobulin=20.88 ± 18.84 mg/g creat versus day 0, urinary alpha-1-microglobulin=4.96 ± 6.57 mg/g creat, p=0.003). No statistically significant alterations of GFR were noticed after 7 days of treatment.


CONCLUSIONS
We found the nephrotoxic effects of gentamicin at tubular level, but not at glomerular level. The nephrotoxic potential of gentamicin in patients with a SK can be monitored by assessing urinary biomarkers during treatment of UTI.
Department of Nephrology, County Emergency Hospital Timisoara, Romania, "Victor Babes" University of Medicine and Pharmacy , Timisoara , Romania and.
Gheorghe
G
Gluhovschi
Florica
F
Gadalean
Cristina
C
Gluhovschi
Silvia
S
Velciov
Ligia
L
Petrica
Flaviu
F
Bob
Gheorghe
G
Bozdog
Adriana
A
Kaycsa
D000118:Acetylglucosaminidase / Q000652:urine*; D000328:Adult; D000510:Alpha-Globulins / Q000652:urine*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000652:urine; D005260:Female; D005839:Gentamicins / Q000009:adverse effects*; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000652:urine; D007687:Kidney Tubules, Proximal / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D014552:Urinary Tract Infections / Q000188:drug therapy*
D000510:Alpha-Globulins; D000900:Anti-Bacterial Agents; D015415:Biomarkers; D005839:Gentamicins; C016001:alpha-1-microglobulin; D000118:Acetylglucosaminidase