Reflux-induced renal parenchymal injury: evaluation by urinary enzyme management

Abstract

The urinary enzymes N-acetyl-B-D-glucosaminidase (NAG) and gamma-glutamyltransferase (GGT) were measured in four paediatric cohorts. Group 1 (21 children) suffered from severe vesico-ureteric reflux (VUR), group 2 (9 children) had active e urinary sepsis without reflux, group 3 constituted the control group (84 children), and group 4 comprised 21 children who had undergone successful endoscopic corrective surgery for VUR. Excretion of both NAG and GGT was significantly greater in group 1 than in groups 2 and 3 (P < 0.05). Within group 1, those with reflux in association with a single ureteric system demonstrated greater enzyme excretion than those with reflux in a duplex moiety (P < 0.05). Following surgical correction of reflux (group 4), there was a significant reduction in urinary enzyme excretion (P < 0.001). A spectrum of renal tubular damage exists in association with VUR. Urinary enzyme measurement is an invaluable technique in the evaluation of such renal damage in reflux, and in quantitatively assessing the efficacy of treatment.