Diagnostic significance of standardized determination of urinary enzymes in the practice of human kidney transplantation and renal toxicology.
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Biomedical subjects
Publications and source records attributed to G Horpácsy.
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Changes in activity of lysosomal enzymes and levels of adenine nucleotides were investigated during hemorrhagic hypotension and following recovery in rat kidneys. The effect of aprotinin pretreatment on these parameters was also tested, and the results were compared to saline-treated controls. Hemorrhagic hypotension led to a release of lysosomal enzymes and to extreme depletion of ATP. The pretreatment with aprotinin inhibits the changes in enzyme activities, but it has no effect on ATP loss during the hypotension. After reinfusion of the shed blood, however, the pretreated animals showed a faster rate of ATP regeneration. The results suggest an interaction between lysosomal enzyme release and ability of mitochondria to resynthetize high-energy compounds during the recovery period.
The effect of prednisone therapy on renal hemodynamics was studied in normal, autotransplanted as well as homotransplanted dog kidneys. After intravenous administration of prednisone (8 and 16 mg/kg/min) the total blood flow decreased and vascular resistance increased significantly. This effect was more pronounced if the drug was directly injected into the arteria renalis. The same changes were observed in autotransplanted and homotransplanted kidneys and in kidneys in rejection. Our results suggest that high dosage of prednisone decreases the renal blood flow and this adverse effect has to be considered in the therapy. The administration of the drug directly into the arteria renalis may have to be avoided.
101 human cadaver kidneys were preserved by means of hypothermic pulsatile perfusion in the Gambro perfusion unit with human albumin as perfusate. Perfusate flow and some biochemical parameters were assessed during perfusion and correlated with renal function after transplantation. There is a good correlation between perfusate flow and recovery of physiological renal function. LDH released to the perfusate as viability test is of limited value: a direct correlation was only found between LDH activity and perfusion time, and LDH activity and ischemia time. Determination of pH and lactic acid level 1 h after beginning of perfusion is without practical value according to our experience. The quality of albumin in perfusion solution influences the immediate graft function.
The action of Trasylol on the lysosomal and ATP changes after renal-stalk clamping in rats was examined. It was found that, in the presence of an effective Trasylol concentration, a distinct stabilization of the lysosomal membrane can be detected after 30 min of renal-stalk clamping. It was also found that there is only an indirect relationship between lysosomal changes and ATP metabolism under the action of Trasylol. The more rapid regeneration of the ATP is a result of the better microcirculation. The results confirm the earlier belief that Trasylol acts primarily on the lysosomal membrane.
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The effect of degree and duration of hemorrhagic hypotension on the lysosomal enzyme and LAP levels of plasma of the anaesthesied or wakeful dog has been examined. We ascertained that in a state of hypovolaemia a reduction by 10 mm Hg of the blood pressure resulting significantly increased enzyme activity during the same time. A similar change was caused by prolonging the time. In the anaesthesised group there was the enzyme activity after 120 min of haemorrhagic hypotension lower.
The activity of LDH in perfusate on human kidney and in experiments on dog kidney was investigated during the preservation by the Gambro perfusion apparatus. The enzyme activity of perfusate was characterized by a quotient of volume activity in relation to the perfusion flow rate. With this method we are able to distinguish the values of damaged and normal kidneys. A correlation was established between this quotient and the function resumption day in human kidney transplantation.
Enzyme and metabolite content of effuent perfusate has been investigated. One kidney was removed from dogs and preserved by Collin's method. The animals were then bled to a mean arterial blood pressure of 5.26 KPa (40 mm Hg) and maintained at this pressure for 60 min after which the other kidney was removed and preserved in a similar way. 10-ml samples of effluent perfusate were taken immediately, and after 30 min, 1, 2, 3, 4, 6, 8, 24, 48 and 72 h. Acid phosphatase, arylsulphatase "A", ss-glucuronidase, LDH, leucin-aminopeptidase, lactic acid and pyruvic acid were determined by fluorometric methods. It was found that the activity of the enzymes rose parallel with the duration of preservation, the rise was especially great at 48 and 72 h. Activity of LDH and arylsulphatase "A" was significantly higher even at the beginning of preservation in the group of kidneys exposed in vivo to hypotension. This significant difference was present at 24, 48 und 72 h in the activity of all enzymes.
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