URINARY-EXCRETION OF RENAL BRUSH-BORDER MEMBRANE ENZYMES IN LEPROSY PATIENTS - EFFECT OF MULTIDRUG THERAPY

Renal function at the brush border membrane level has been studied usi ng characteristic enzymes, such as alkaline phosphatase, leucine-amino peptidase and gamma-glutamyl transpeptidase. Urinary enzyme studies we re performed using leprosy patients, classified on the basis of bacter iological index (BI > 3; n = 20, BI < 3; n = 12, BI-ve; n = 10) and co mpared with control subjects (n = 10). The role of enzymuria in monito ring WHO-recommended multidrug therapy (MDT) has been evaluated in the se patients. A significant increase in the enzyme activities (p < 0.01 ), as well as significant (p < 0.01) proteinurea in 24-hour urine samp les of both the smear positive groups (Bf > 3, BI < 3) prior to therap y compared to control subjects, indicates proximal tubular functional impairment at brush border membrane level. In the smear negative (BI-v e) group, no significant difference was observed in enzyme activities as compared with the control group. In a follow-up study (BI > 3; n = 13, BI < 3; n = 4) the activities of all the enzymes decreased signifi cantly in all the groups when compared to a corresponding untreated gr oup. The follow-up study was not carried out on the smear negative gro up. The surprising finding was the differential behaviour of r-glutamy l transpeptidase, whose activity increased significantly (p < 0.01) ev en after therapy in BI > 3 group when compared with untreated patients . However in a detailed work-up including hepatic and renal function t ests, the serum biochemistry was found to be normal both before and af ter therapy. Urinary excretion of brush border enzymes seems to be rel ated to bacterial load, and their potential in studying the effect of MDT remains unclear.