Randomized Multi Center Study Comparing Nephrotoxicity of Ceftazidime Versus the Combination of Piperacillin and Netilmicin with and without Furosemide

  • A. Werner Mondorf
  • Christina Bonsiepe
  • Wolfgang Mondorf
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 252)


In human subjects, it is very difficult to correlate the extent of tissue damage and change in kidney function during administration of potentially nephrotoxic durgs (1–3). The rise of creatinine in the serum and the decrease of creatinine clearance are a late manifestation of renal nephrotoxicity (4). In early phases of renal nephrotoxicity, the so-called “creatinine blind phase”, the release of several renal tissue enzymes can be used an markers of early tissue damage (5). Among those enzymes are: alanine-aminopeptidase (AAP), alkaline phosphatase (AP), gamma-glutamyl- transpeptidase (g-GT), n-acetyl-3-d-glucosaminidase (NAG) etc.(6). Previous clinical results did show that increasing elimiation of the brush border enzyme AAP always preceded changes of functional parameters (7). For assessment of tubular toxicity of drugs in clinical trials AAP determination in urine is useful because of the recognition of tubular alteration or injury in an early phase long before glomerular paramenters show definite changes. Effects of aminoglycosides in recommended dosages lead to an alteration of tubular cells with the release of increasing amounts of marker enzymes into urine according to the accumulation of the drug in the tubular cells (8). AAP elimination in urine is dependent on dose regimen and sex (9). During tubular alteration of the total amount of enzyme activity in tubular cells increase (10). Lesions of tubular cells are characterized by the appearance of aggregates of enzymes and membrane fragments in urine. In this stage the creatinine-clearance decrease. During tubular necrosis filaments and cytoskeleton appears in urine (6), e.g. under treatment with cis-paltiniam (7). In volunteer studies we need such early phase paramenters, since it would not be ethical to continue the application of drugs up to the point when we recognize changes in serum creatinine or decreasing creatinine-clearance. For the following reasons we chose the AAP as an useful parameter for determination of toxic tubular alteration or damage.


Tubular Cell Tubular Membrane Potential Nephrotoxicity Prospective Open Distal Tubular Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    L.F. Prescott, Assessment of nephrotoxicity, Br.J.din.Pharmacol. 13: 303–311 (1982).CrossRefGoogle Scholar
  2. 2.
    R.G. Price, Urinary Enzymes, Nephrotoxicity and Renal Disease, Toxicology 23: 99–134 (1982).PubMedCrossRefGoogle Scholar
  3. 3.
    U. Burchardt, G. Schinkothe, K. Meinel, D. Anton, I. Krebbel and L. Neef, Aminoglycosidnephropathie, Z. Gesmt Inn. Med. 37: 388–392 (1982).Google Scholar
  4. 4.
    A.W. Mondorf, W. Schoeppe, Is the Potential Nephrotoxicity of Drugs Predictable?, Contributions to Nephrology 42: 39–99 (1984).Google Scholar
  5. 5.
    A.W. Mondorf, J. Breier, J. Hendus, J.E. Scherberich, G. Mackenrodt, P.M. Shah, W. Stille, W. Schoeppe, Effect of amonoglycosides on proximal tubular membranes of the human kidney, Eur. J. Clin. Pharmacol. 13: 133–142 (1978).PubMedCrossRefGoogle Scholar
  6. 6.
    F.W. Falkenberg, U. Mondorf, D. Pierard, C. Gauhl, A.W. Mondorf, U. Mai, G. Kantwerk, U. Meier, A. Rindhage, M. Rohracker. Identification of Fragments of Proximal and Distal Tubular Cells in the Urine of Patients und Cytostatic Treatment by Immunoelectronmicroscopy with Monoclonal Antibodies, American Journal of Kidney Diseases, Vol IX, No 2: 129–137 (1987).Google Scholar
  7. 7.
    P.S. Mitrou, A.W. Mondorf, U. Otto, K. Völker, B. Simon, cis-Plati-num nephrotoxicity: effect o excretion of tubular membrane enzyme alanine aminopeptidase, 11th Int. Congr. Chemother., vo. 2: 1709–1711 (1979).Google Scholar
  8. 8.
    P.G. Davey, A.M. Geddes, D.M. Cowley, Study of alanine aminopeptidase excretion as a test of gentamicin nephrotoxicity, J. Antimicrob. Chemother. 11: 455–465 (1983).PubMedCrossRefGoogle Scholar
  9. 9.
    A.W. Mondorf, Urinary enzymatic marker of renal damage, in Whelton, Neu, The aminoglycosides. Dekker, New York: 283–301 (1982).Google Scholar
  10. 10.
    G. Heinert, A.W. Mondorf, Quantiative enzymatic and immunologic histophotometry of diseased human kidney tissues using TV – camera and computer-assisted image processing systems, Proc. 1st Int. Symp. Med. Imaging and Image Interpretation: 232–238 (1982).Google Scholar
  11. 11.
    M. Nakamura, T. Itoh, K. Miyata, T. Uchisaka, T. Tanabe, M. Aono, K. Kimura, Protection by Glycerol of Urinary -L-Alanine Aminopeptidase Activity from Freezing and Thawing Inactivation, Toxicology Letters 21: 321–324 (1984).PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1989

Authors and Affiliations

  • A. Werner Mondorf
    • 1
  • Christina Bonsiepe
    • 1
  • Wolfgang Mondorf
    • 1
  1. 1.Zentrum der Inneren MedizinUniversitatskliniken FrankfurtFrankfurt 70Germany

Personalised recommendations