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저삼투질 비이온성 조영제에 의한 신손상시 뇨중 N - Acetyl - β - D Glucosaminidase ( NAG ) 활성도의 의의
이준승(Jun Seung Lee),박지현(Jee Hyoun Park),곽귀철(Guee Chul Kwak),오동진(Dong Jin Oh),민철홍(Cheol Hong Min),강응택(Eung Taek Kang),유석희(Suk Hee Yu) 대한내과학회 1996 대한내과학회지 Vol.51 No.5
N/A Objectives: It has been claimed that the incidence of the contrast media induced nephrotoxicity (CMN) was reduced with the introduction of the nonionic low-osmolar contrast media (CM). The commonly used diagnostic tools for nephrotoxicity including serum creatinine levels, creatinine clearance and urine analysis cannot detect damage of renal proximal tubule in early stage. Urine N-Acetyl-β-D Glucosaminidase (NAG) is well documented a useful indicator for proximal tubular damage. Therefore we investigated incidence of nonionic low-osmolar CMN and whether the urine NAG activity could be used as a indicator of CMN. Methods: We studied 32 patients with normal renal functions (mean age: 58.7, M:F=23:9) and assayed their serum concentration of creatinine, urine NAG activities and SDS-PAGE profiles in the urine for 5 days after exposure to CM. Results: Mean creatinine level of 32 patients did not increase in comparison to their preexposure level on post exposure day 1, 3 and 5. But mean urine NAG activities increased significantly in comparison to their preexposure activities from day 1 to day 4 (p<0.05). Serum creatinine level increased either more than 50% or at least 1㎎/dL comparing the preexposure levels in 5 patients (15.6%) and did not in 27 patients (84.4%) and urine NAG activities increased from day 1 to day 4 in the former group and from day 1 to day 3 in latter group (p<0.05). Serum creatinine level increased either more than 20% or at least 0.3㎎/dL comparing the preexposure levels in 13 patients (40.6%) and did not in 19 patients (59.4%) and urine NAG activities increased from day 1 to day 3 in two groups (p<0.05). Serum creatinine level increased only 25% (sensitivity) of the patients with low molecular weight (LMW) protein in their urine SDS-PAGE and did not increased 90% (specificity) of the patients without LMW protein in their urine SDS-PAGE (50% or 1.0㎎/dL). The sensitivity and specificity of creatinine level were 33.3% and 55% (20% or 0.3㎎/dL) upon SDS-PAGE. Urine NAG activity revealed 76.9% of sensitivity and 52.6% of specificity. Conclusion: Nonionic low-osmolar contrast media, compared to ionic high osmolar contrast media, results in similar incidence of CMN and have the potential CMN subclinically. Urine NAG activity can be a useful indicator for CMN.
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