Evaluation of renal tubular damage in liver cirrhosis by urinary enzymes and beta‐2‐microglobulin excretions

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Abstract
The renal tubular damage in liver cirrhosis was assessed. The fractional clearances of .beta.-2-microglobulin (B2m-fr.cl) and malate dehydrogenase (MDH-fr.cl) were measured, respectively, in 64 and in 46 out of 79 patients with liver cirrhosis of different etiology; the fractional excretions of .gamma.-glutamyl transpeptidase (fr-GGT) and of .alpha.-glucosidase (fr-AGL) were determined in 53 and in 40 of them, respectively. In all patients glomerular filtration rate (GFR) and renal plasma flow (RPF) were also measured. Subjects (25) were studied as a control group for the enzyme excretions, 16 for B2m-fr.cl. B2m-fr.cl and MDH-fr.cl (indexes of tubular functions) on the average were normal and only slightly increased, respectively, in cirrhotics compared to controls. Nevertheless fr-GGT and fr-AGL.sbd.indexes of cytolysis of tubular cells.sbd.on the average were massively increased in cirrhotics compared to controls, particularly in those with reduced RPF and/or GFR. No clear relationship between the indexes of tubular damage studied and the indexes of liver function was found. A renal tubular anatomical damage was found by means of an increase in the release of enzyme from tubular cells in patients with liver cirrhosis, particularly in those with a significant reduction of RPF and/or GFR; even so renal reabsorbtion of low MW proteins is generally maintained. The tubular damage is apparently not related to the degree of liver impairment.