REFLUX-INDUCED RENAL PARENCHYMAL INJURY - EVALUATION BY URINARY ENZYME MANAGEMENT

The urinary enzymes N-acetyl-B-D-glucosaminidase (NAG) and gamma-gluta myltransferase (GGT) were measured in four paediatric cohorts. Group 1 (21 children) suffered from severe vesico-ureteric reflux (VUR), grou p 2 (9 children) had active urinary sepsis without reflux, group 3 con stituted the control group (84 children), and group 4 comprised 21 chi ldren who had undergone successful endoscopic corrective surgery for V UR. 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 i n association with a single ureteric system demonstrated greater enzym e excretion than those with reflux in a duplex moiety (P <0.05). Follo wing 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 measurem ent is an invaluable technique in the evaluation of such renal damage in reflux, and in quantitatively assessing the efficacy of treatment.