Abstract
Aim: To estimate the effect of initial therapy with Paracetamol and Ketoprofen on glomerular and tubular integrity in patients with Rheumatoid arthritis (RA), to quantify the toxicity of these drugs through measurements of the enzyme excretion that correlates with the damage degree on the tubular epithelium. Microalbuminuria is used as a marker for glomerular damage, and the urinary excretion of N-Acetyl-?-D-glucozaminidase (NAG) as an indicator of proximal tubular damage. To determine if there is a change in the clinical indicators of renal function (serum urea and creatinine, urine urea and creatinine, glomerular filtration rate - GFR) in the course of disease and if that change correlates with the dynamics of the quantity of excreted enzymes in urine, reactants of the acute pfase and index of disease activity (DAS28). Methods: Using the colorimetric method for the determination of NAG, as well as immunoturbidimetric immunoturbidimetric assay for detection of microalbuminuria, we examined samples of 70 participants (35 RA pts treated only with Paracetamol, 35 RA pts treated with Ketoprofen), followed up in five time intervals in the course of 24 weeks. Rheumatoid factor (RF) is determined by the agglutination test (Lateks RF test) in the same participants. Results: there is a weak correlation between NAG and microalbuminuria (r=0.16) in the group of patients treated with Paracetamol, while in the group treated with Ketoprofen there is a moderate correlation (r=0.28). NAG Arch Clin Biomed Res 2016; 1 (1): 20-31 21 enzymuria in range, in number of examined patients and in the time of appearance is greater and appears earlier in the group with Ketoprofen compared with the group of Paracetamol. Conclusions: Ketoprofen is a more potent NAG inductor and triggers greater tubular enzymuria than Parcetamol.
Highlights
The use of drugs in the treatment of Rheumatoid arthritis (RA) aims to shorten disease duration and prevent complications
Analyzing the group of patients treated with Paracetamol in comparison with the distribution of patients, according to N-Acetyl- -D-glucozaminidase (NAG) values in the four samples, one can conclude that NAG values are registered in 20 patients in the 12th week, when the degree of the mean urine NAG value is highest (1.20 ± 1.04)
Testing the significance of the differences in both groups in the 0 sample in the group of patients treated with Paracetamol, the mean value of the NAG enzymuria is in the range 0.93±0.48, while in the group of patients treated with Ketoprofen is 1.59±0.67
Summary
The use of drugs in the treatment of Rheumatoid arthritis (RA) aims to shorten disease duration and prevent complications. There are a lot of findings recently which show that drugs can damage certain organs caused by their toxic effect due to their accumulation in the organs. A lot of experiments were realized in the previous two decades, aiming to follow the toxic effect of pharmacotherapy to kidneys. These results are used as a base to follow up the influence of drugs in different kidney diseases. In these experiments, beside immunologic, radiologic and cytologic analyses, an important role play biochemical analyses for detection of certain pathologic conditions caused in the course of treatment. Determination of enzymes’ and their isoenzymes activity in the serum, urine and renal tissue has an important role
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