muramidase and Renal-Insufficiency

Kidney failure is common in haematologic malignancies. However, the nephrotoxic effect of lysozyme is seldom recognized. We present a 78-year-old male with chronic myelomonocytic leukaemia who developed progressive kidney failure due to increased production of lysozyme.

Topics: Aged; Disease Progression; Humans; Leukemia, Myelomonocytic, Chronic; Liver; Male; Muramidase; Renal Insufficiency

Topics: Acute Kidney Injury; Aged; Comorbidity; Diagnosis, Differential; Fanconi Syndrome; Glycosuria; Humans; Kidney Diseases; Kidney Tubules, Proximal; Male; Muramidase; Renal Insufficiency; Sarcoidosis

Topics: Aged; Biopsy; Diagnosis, Differential; Humans; Kidney; Leukemia, Myelomonocytic, Chronic; Male; Muramidase; Renal Insufficiency

Lysozyme values are sometimes used as an aid for diagnostic subtyping of acute myeloid leukaemia (AML), since monocytic forms often show high levels. We wanted to study if pretreatment serum lysozyme has any relation to prognosis in AML. For this purpose, 232 adult AML patients who had received remission induction therapy at two hospitals were reviewed retrospectively. Their median age was 65.5 yr. Sixty-three patients were FAB classified as "monocytic" AML (M4, M5) and 169 as "non-monocytic" AML (M0, M1, M2, M3, M6). A linear relation was rejected, and a bimodal relation was found between lysozyme and prognosis where values below 20 or above 80 mg L-1 were indicative of better outcome than values in the range 20-80 mg L-1. Analysed in three categories with cut-off levels at 20 and 80 mg L-1, lysozyme showed an independent effect on complete remission (CR) frequency (P = 0.0003), overall survival (P < 0.0001), and CR duration (P = 0.0005) in multivariate analysis. The hazard ratios (HR) for lysozyme <20, 20-80, and >80 mg L-1 regarding overall survival were 1.0, 3.3, and 0.7. Influence of lysozyme on survival was bimodal both in "non-monocytic" AML (HR 1.0, 3.0, and 0.1) and M4-M5 (HR 1.0, 10.1, and 1.2). Our finding of a bimodal relation between serum lysozyme and prognosis in AML should be regarded as a new hypothesis and controlled in other studies.

Topics: Acute Disease; Aged; Biomarkers; Clinical Enzyme Tests; Female; Humans; Kidney Function Tests; Leukemia, Myeloid; Male; Middle Aged; Multivariate Analysis; Muramidase; Prognosis; Renal Insufficiency; Reproducibility of Results; Retrospective Studies; Survival Analysis

The aim of this study is to evaluate the effects of contrast media on both tubular and glomerular function. Different parameters of tubular and glomerular function were determined before and at 1, 3, and 5 days after the intravascular administration of contrast media in 100 adult renal patients (plasma creatinine 0.6-10.8 mg/dL, mean: 1.3). Urinary activities of five tubular enzymes (alanine aminopeptidase, gamma-glutamyltransferase, alkaline phosphatase, lactate dehydrogenase, N-acetyl-beta-D-glucosaminidase) increased significantly on the first day after the administration of contrast media, indicating a tubular damage. Glomerular filtration rate and the conventional tests of glomerular function (plasma creatinine, creatinine clearance, and urinary proteins) presented only slight variations after the administration of contrast media. In conclusion, contrast media principally affected the renal tubule (as demonstrated by enzymuria), while their effects on glomerular function were very mild.

Topics: Acetylglucosaminidase; Adolescent; Adult; Aged; Alanine Transaminase; Alkaline Phosphatase; Contrast Media; Creatinine; Female; gamma-Glutamyltransferase; Glomerular Filtration Rate; Humans; Infusions, Intravenous; Kidney Glomerulus; Kidney Tubules; L-Lactate Dehydrogenase; Male; Middle Aged; Muramidase; Renal Insufficiency