Lysozymuria and acute disorders of renal function

Abstract

On the assumption that increased urinary lysozyme concentration (`lysozymuria') indicates tubular proteinuria and therefore impaired tubular function, urinary lysozyme has been estimated in acute disorders where transient disturbances of renal function might be expected, in cases diagnosed clinically as extrarenal uraemia, and in a few examples of acute renal disease. Reversible lysozymuria occurred with hypokalaemia, postoperative `collapse', electrolyte depletion, severe extrarenal infection, acute pyelonephritis, the nephrotic syndrome, after a few apparently uncomplicated surgical operations, and very transiently after ventricular fibrillation abolished by DC shock. There was no lysozymuria with severe uraemic heart failure, aspirin and paracetamol poisoning, or severe jaundice, nor in two cases of acute glomerulonephritis. Although lysozymuria may occasionally be useful in the clinical diagnosis of acutely disordered renal function, the results suggest that its value is limited; on the other hand, they have provided information on renal pathophysiology in acute disease.

Spectrum of renal tubular damage in renal failure secondary to cirrhosis and fulminant hepatic failure.

“…In 21 healthy control subjects the fractional clearance of lysozyme ranged from 0 to 1 %, which is comparable to 0 to 1-6% calculated from the data of Harrison et al (1973), assuming a normal creatinine clearance of 120 ml/min and a 24-hour urine volume of 1500 ml. In the control subjects the urine lysozyme concentration ranged from 0 to 5-3 mg/I, which is comparable to values from several other laboratories (Barratt and Crawford, 1970;Harrison et al, 1973;Farr et al, 1976).…”

A Forgotten Cause of Kidney Injury in Chronic Myelomonocytic Leukemia

“…We therefore cannot estimate the ratio of urinary lysozyme to urinary albumin or immunoglobulin. Harrison et al24 performed extensive analysis of urine and serum lysozyme in the context of various disease states. Their data suggests that lysozyme excretion may be highly variable in patients with this disorder.…”

Hipopotasemia recurrente y de difícil control en un paciente con leucemia linfoide aguda

“…Dado el cuadro clínico de la paciente se concluyó que su tubulopatía era secundaria a la lisozimuria que se puede encontrar en estos pacientes y que sí explicaba claramente la hipopotasemia grave resistente al manejo, ya que la lisozima se produce en grandes cantidades en los pacientes con leucemia activa y al eliminarse por vía renal (lisozimuria) produce tubulopatía y kaliuresis abundante (2,3,28). Como la causa de base no se pudo corregir porque la paciente optó por el manejo paliativo, se hizo tratamiento de la tubulopatía renal con suplemento de potasio inicialmente parenteral y luego oral, bicarbonato de sodio, citrato de potasio, calcitriol y espironolactona; hubo buena respuesta a la terapia en cuanto a la corrección del trastorno ácido-base y electrolítico (29).…”