Experimental Studies on the Modification of Urinary Alanine Aminopeptidase (AAP) and N-Acetyl--D-Glucosaminidase (NAG) in Patients Submitted to Intraperitoneal Hyperthermic Chemoperfusion (HIIP)

Introduction: NAG and AAP have been utilized as indicators of renal disease or tubular damage. This study was aimed at analysing the variation of enzymes value in patients submitted to HIIP. Methods: The 24-hours urinary escretion of NAG and AAP was measured on p.o. day 3 in 46 patients who underwent HIIP for peritoneal carcinomatosis (TG) and in 25 patients submitted to major surgical procedures (CG). Results: In the CG, a significant difference between mean preoperative and p.o. values of NAG (5.8 vs. 10; p 0.04) were observed. A difference between mean p.o. values of NAG (25.4 vs. 10; p 0.01) and AAP (29 vs. 16.8; p 0.07) was observed in TG with respect to CG. In TG, complications were observed in 41.3%. No differences in mean value of NAG and AAP were observed according to overall complications (p 0.20 and p 0.28), also considering surgical (p 0.11 and p 0.45) or medical separately (p 0.53 and p 0.80). An extremely high value of urinary enzymes was observed in patients with intestinal fistula and fluid collection (NAG: 62.7 and 67; AAP: 27.2 and 81.9). In TG, a significantly higher value of enzymes was observed for patients with grade 2–3 renal toxicity (NAG: 59.6; p 0.001; AAP: 61.9; p 0.006). No difference was observed according to other variables. Discussion: p.o. value of NAG and AAP was significantly higher in TG in relation to tubular damage induced to treatment. p.o. assessment of enzymes should play a role in prediction of septic surgical related complications as well as severe renal toxicity.