Urinary glycosaminoglycan excretion in urolithiasis - Archives of ...
Urinary glycosaminoglycan excretion in urolithiasis - Archives of ...
Urinary glycosaminoglycan excretion in urolithiasis - Archives of ...
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272 Akçay, Konukog˘lu, Dínçer<br />
The control subjects had a mean (SD)<br />
GAG/creat<strong>in</strong><strong>in</strong>e ratio <strong>of</strong> 31.67 (12.76). We<br />
found no diVerences between girls and boys <strong>in</strong><br />
mean (SD) ur<strong>in</strong>ary GAG/creat<strong>in</strong><strong>in</strong>e ratio<br />
(33.34 (9.43), 30.39 (14.69), respectively). In<br />
patients, the mean (SD) ur<strong>in</strong>ary GAG/<br />
creat<strong>in</strong><strong>in</strong>e ratio was significantly lower (22.59<br />
(7.35)) than <strong>in</strong> control subjects (p < 0.005).<br />
Discussion<br />
In adults with calcium stones a higher ur<strong>in</strong>ary<br />
<strong>excretion</strong> <strong>of</strong> calcium, oxalate, and urate as well<br />
as a deficiency <strong>in</strong> <strong>in</strong>hibit<strong>in</strong>g substances has<br />
been reported repeatedly. There have been<br />
numerous reports show<strong>in</strong>g that ur<strong>in</strong>ary GAGs<br />
are low <strong>in</strong> adult patients with nephrolithiasis.<br />
1 3 11 12 We also found that ur<strong>in</strong>ary GAG<br />
concentrations were significantly lower <strong>in</strong><br />
adults with <strong>urolithiasis</strong>. 9 However, although<br />
Michelacci et al suggested that ur<strong>in</strong>ary GAG<br />
<strong>excretion</strong> <strong>in</strong> children with <strong>urolithiasis</strong> was<br />
significantly lower, 6 these data have not been<br />
confirmed by others.<br />
7 8<br />
The mean (SD) ur<strong>in</strong>ary GAG concentrations<br />
<strong>in</strong> 15 healthy children were reported as<br />
17.00 (15.60) mg/day by Lama et al. 7 However,<br />
Baggio et al reported that the mean (SD) GAG<br />
concentrations <strong>in</strong> healthy children were 61.26<br />
(17.94) mg/l and found no significant diVerence<br />
<strong>in</strong> ur<strong>in</strong>ary GAG <strong>excretion</strong> between<br />
children with idiopathic <strong>urolithiasis</strong> and<br />
healthy controls. 8 Michelacci et al reported a<br />
mean (SD) GAG/creat<strong>in</strong><strong>in</strong>e (mg/g) ratio <strong>of</strong><br />
24.33 (1.91) <strong>in</strong> healthy children 6 ; this result is<br />
close to our f<strong>in</strong>d<strong>in</strong>gs <strong>of</strong> 31.67 (12.76).<br />
Discrepancies between data from diVerent<br />
studies might be caused by the diVerent methods<br />
used to measure GAGs. In the literature,<br />
the measurement <strong>of</strong> ur<strong>in</strong>ary GAG concentrations<br />
is commonly performed by the<br />
borate−carbazole method or other procedures<br />
<strong>in</strong>volv<strong>in</strong>g the basic metachromatic dye, alcian<br />
blue. The borate−carbazole method measures<br />
the hexuronic acid residues <strong>of</strong> GAG molecules<br />
and, therefore, cannot detect keratan sulphate<br />
because the hexuronic acid residues are<br />
replaced with galactose <strong>in</strong> keratan sulphate. 10<br />
In addition, other procedures <strong>in</strong>volv<strong>in</strong>g the use<br />
<strong>of</strong> alcian blue are not specific for ur<strong>in</strong>ary GAGs<br />
because negatively charged molecules, other<br />
than sulphated GAGs, <strong>in</strong>terfere with the<br />
assay. 13 F<strong>in</strong>ely dispersed precipitates obta<strong>in</strong>ed<br />
with alcian blue are <strong>of</strong>ten diYcult to<br />
harvest. 13 14 On the other hand, Hesse et al<br />
<strong>in</strong>dicated that there was a diurnal rhythm <strong>in</strong><br />
ur<strong>in</strong>ary GAG <strong>excretion</strong>. 15 As GAG <strong>excretion</strong><br />
was highest <strong>in</strong> the morn<strong>in</strong>g and lowest at night,<br />
24 hour ur<strong>in</strong>e collection would avoid falsely<br />
high results. Therefore, we performed the<br />
GAG measurements <strong>in</strong> 24 hour ur<strong>in</strong>e specimens<br />
and we also calculated total GAG<br />
concentration by us<strong>in</strong>g the GAG/creat<strong>in</strong><strong>in</strong>e<br />
ratio <strong>in</strong> 24 hour ur<strong>in</strong>e samples, which gives<br />
more reliable results. 16<br />
A procedure <strong>in</strong>volv<strong>in</strong>g the use <strong>of</strong> the basic<br />
metachromatic dye dimethylene blue, which<br />
we used for the first time to determ<strong>in</strong>e GAG<br />
concentrations <strong>in</strong> the ur<strong>in</strong>e <strong>of</strong> children with<br />
stones, is reported to be more sensitive than the<br />
other methods used to analyse ur<strong>in</strong>ary GAG<br />
concentrations <strong>in</strong> patients with <strong>urolithiasis</strong>. 12<br />
Our data lead us to propose that ur<strong>in</strong>ary<br />
GAG may play an important role <strong>in</strong> the<br />
prevention and reduction <strong>of</strong> calculi <strong>in</strong> children,<br />
as has been found <strong>in</strong> adults. 9<br />
The authors thank the Department <strong>of</strong> Paediatrics <strong>of</strong> Cerrahpas¸a<br />
Medical School for their cl<strong>in</strong>ical assistance.<br />
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