We prospectively evaluated concentrations of β-D-galactosid- ase, α-L-fucosidase, β-D-N-acetylglucosaminidase, and lysozyme in urine from normal subjects, ambulatory patients with cystic fibrosis (CF), and CF patients with previously normal renal function who were receiving intravenous aminoglycoside (AG) therapy. Enzyme activities were generally low or negligible in subjects not receiving AG. Enzymuria was documented during 12 of 13 AG treatment courses and most frequently involved β-D-N-acetylglu- cosaminidase excretion. In nine courses, enzymuria occurred in the absence of proteinuria or elevations of blood urea nitrogen and serum creatinine. In three courses attended by enzymuria and evidence of nephrotoxicity, neither the time of appearance nor the magnitude of enzymuria was different from that of nonnephrotoxic patients. In two of these three treatment courses, enzymuria preceded clinical evidence of nephrotoxicity by 16 and 5 days, and in the third course enzymuria and elevation of blood urea nitrogen and serum creatinine occurred simultaneously. We conclude that enzymuria is not a reliable predictor of nephrotoxicity due to AG in CF patients and is not an indication to discontinue AG therapy. Speculation: Measurement of urinary enzyme excretion after aminoglycoside therapy appears to be too sensitive a test to be clinically useful as a predictor of aminoglycoside-associated nephrotoxicity in patients with cystic fibrosis.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health