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Urinary N-acetyl-beta-D glucosaminidase (NAG) level in idiopathic nephrotic syndrome

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Abstract

Urinary N-acetyl-beta-D glucosaminidase (NAG) is a sensitive biomarker of renal parenchymal disease. The aim of this study was to investigate variations in the levels of NAG excretion among different sub-groups of nephrotic syndrome (first episode, relapsers, and resistant) and its prediction based on proteinuria. Thirty-five patients with idiopathic nephrotic syndrome, aged 1–12 years, as well as 15 age- and gender-matched normal children (controls) were enrolled in the study. Among the 35 patients, ten were classified with first episode nephrotic syndrome (FENS), 17 with relapsing nephrotic syndrome (RNS), and eight with steroid-resistant nephrotic syndrome (SRNS). Urinary NAG/creatinine levels were significantly increased in SRNS patients as compared to FENS and RNS patients (p < 0.001); the FENS and RNS groups had comparable levels. A urinary NAG/creatinine value of ≤108.9 U/g was found to identify steroid-sensitive patients with a sensitivity, specificity, positive predictive value, and negative predictive value of 78.8, 100, 100 and 77.7%, respectively. Significant correlations were found between experimental and predicted values of urinary NAG/creatinine in steroid sensitive nephrotic syndrome (SSNS) (R 2 = 0.9643) and SRNS patients (R 2 = 0.9823). Urinary NAG/creatinine values were found to be higher in SRNS than SSNS patients and have moderate predictive value for steroid responsiveness. This level can be obtained based on urinary protein/creatinine ratio or 24 h urinary protein levels.

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Abbreviations

FENS:

First episode nephrotic syndrome

MCD:

Minimal change disease

NAG:

N-acetyl-beta-D glucosaminidase

RNS:

Relapsing nephrotic syndrome

SRNS:

Steroid-resistant nephrotic syndrome

SSNS:

Steroid-sensitive nephrotic syndrome

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Acknowledgments

The authors are grateful to Dr. Narendra K Tiwary for helping with the statistical analysis and to the Finance Officer of Banaras Hindu University for providing the research grant which enabled us to carry out this study.

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Authors and Affiliations

  1. Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Om P. Mishra, Priyanka Jain & Rajniti Prasad

  2. School of Biochemical Engineering, Institute of Technology, Banaras Hindu University, Varanasi, 221005, India

    Pradeep Srivastava

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  1. Om P. Mishra
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  2. Priyanka Jain
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  4. Rajniti Prasad
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Correspondence to Om P. Mishra.

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Mishra, O.P., Jain, P., Srivastava, P. et al. Urinary N-acetyl-beta-D glucosaminidase (NAG) level in idiopathic nephrotic syndrome. Pediatr Nephrol 27, 589–596 (2012). https://doi.org/10.1007/s00467-011-2041-4

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  • DOI: https://doi.org/10.1007/s00467-011-2041-4

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