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ABSTRACT. Urinary excretions of β2‐microglobulin (β2M), N‐acetyl‐β‐D‐glucosaminidase (NAG), alanine aminopeptidase, β‐glucuronidase, acid and neutral α‐glucosidase as indicators of proximal tubular dysfunction were measured in patients with acute upper and lower urinary tract infection (UTI) and fever of non‐renal origin. The sensitivity of β2M was 67% and of NAG 49% as assessed in more than 100 episodes of acute pyelonephritis. Combined use of β2M and NAG increased the sensitivity to 75%. The degree of β2‐microglobulinuria and enzymuria was comparable in patients with acute pyelonephritis and fever due to non‐renal infections. The excretion of β2M and the various enzymes was too variable and unpredictable in individual cases to be useful as diagnostic indicator. In localizing an acute UTI, tests for proximal tubular dysfunction seem to be of no more clinical value than properly measured body temperature.

SUMMARY Thirteen newborn infants, 8 term and 5 preterm (gestational age 31 to 36 weeks), were treated for between 3 and 7 days with gentamicin and ampicillin or cloxacillin because of suspected bacterial infection. The dosage of gentamicin was carefully monitored by serum concentration assays. Urinary alanine aminopeptidase, urinary P2-microglobulin, serum urea, and serum f2-microglobulin were measured during and after the end of treatment to detect signs of renal toxicity. Levels of urinary aminopeptidase increased in 12 of them, indicating damage to the cells of the proximal tubuli. Changes in urinary 32-microglobulin followed the normal physiological course seen in neonates after birth. Serum levels of urea and 32-microglobulin did not indicate any drugassociated depression of glomerular filtration rate.In recent years it has been demonstrated that in most adults the kidneys are affected by therapeutic doses of gentamicin. After only one injection there is an increase in the urine of enzymes from renal tubular cells-for example, alanine aminopeptidase (AAP).' In many patients there is also an increase in the urinary excretion of ,B2-microglobulin, indicating a reduced reabsorptive capacity of the proximal tubuli.2 Moreover, a small but significant decrease of glomerular filtration rate (GFR), as measured by 51chrome-EDTA clearance, has been demonstrated.2 This decrease is accompanied by a significant increase in serum P2-microglobulin, but not in serum creatinine.Aminoglycoside-associated nephrotoxicity is considered to be rare in infants, but it is difficult to assess renal function and to determine which changes are drug associated and which are dependent on other factors.3 5 Clearance determinations may be difficult to perform in neonates. Serum urea, commonly used to approximate GFR, is influenced by the increased protein intake after birth.6 Furthermore, renal function in neonates alters according to gestational age6 and pronounced changes in both glomerular and tubular function occur after birth.6The aim of this study was to search for signs of renal toxicity in neonates treated with gentamicin. Levels of urinary AAP and urinary 3 2-microglobulin were used to evaluate effects on the proximal tubuli.

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Heterotopic transplantation of a duct-ligated canine pancreas was performed in 20 previously pancreatectomized, non-related recipient dogs. A technical procedure was elaborated for this grafting. It was found that early, fatal postoperative bleeding in the recipient could be avoided when the interval between pancreatectomy and transplantation was reduced from 7 to 2–4 days. The early endocrine function was studied in 15 surviving animals by determination of blood glucose and serum insulin during fasting and during glucose load. 24 h after transplantation the blood glucose values were normal and 4–8 days after transplantation the glucose tolerance was within normal limits. The serum insulin was on a supranormal level, also during glucose load. The early endocrine capacity of the transplanted duct-ligated pancreas after transplantation was found to be satisfactory, restoring the blood glucose in the pancreatectomized recipients to normal levels.