Tas Nesrin, Balci Ozge, Senes Mehmet, Bicakci Sukran, Yılmaz Arzu
Nesrin Tas, MD, Department of Pediatric Nephrology, University of Health Sciences Ankara Training, Research Hospital, Ankara, Turkey.
Ozge Balcı, MD, Department of General Pediatrics, University of Health Sciences Ankara Training, Research Hospital, Ankara, Turkey.
Pak J Med Sci. 2025 Apr;41(4):997-1002. doi: 10.12669/pjms.41.4.10385.
Clinical and subclinical evidence of kidney dysfunction has been reported with the use of some anti-epileptic drugs (AEDs) in children. This study aimed to evaluate renal tubular and glomerular functions using novel biomarkers N-acetyl-β-d-glycosaminidase (NAG), Kidney Injury Molecule-1(KIM-1) and 24-hour measured creatinine clearance (mCl) in patients taking valproic acid (VPA) and levetiracetam (LEV).
Fifty-one epileptic patients were included in this prospective case-control study between January 2023 and January 2024 in The Ankara Training and Research Hospital. Exclusions were made for individuals on multiple AEDs, those with incomplete data, bedridden patients, concurrent conditions (hypertension, obesity), or those using steroids or other medications. Participants had been on either VPA or LEV for at least six months. Sixteen healthy age- and sex-matched children served as the control group. Blood samples and 24-hour urine NAG, KIM-1, and mClcr measurements were collected.
The VPA, LEV, and control group comprised 30, 21, and 16 patients, respectively. The VPA group had higher urinary pH (6.1±0.7) and mCl levels (173.4±48.0) than LEV (5.6±0.5, 149.7±39.1) and control (5.6±0.6, 130.6±30.6) groups. No significant difference was observed in urinary pH and mCl levels between the LEV and control groups . No statistically significant differences were observed among the VPA, LEV, and control groups regarding 24-hour urinary NAG, KIM-1, NAG/creatinine, and KIM-1/creatinine levels . There was no significant association between mCl levels and duration of treatment or serum drug levels on Spearman's correlation coefficient .
We found VPA-associated glomerular hyperfiltration in children with epilepsy. We did not observe tubular dysfunction in patients on VPA or LEV.
有报道称，儿童使用某些抗癫痫药物（AEDs）会出现肾脏功能障碍的临床和亚临床证据。本研究旨在使用新型生物标志物N-乙酰-β-D-氨基葡萄糖苷酶（NAG）、肾损伤分子-1（KIM-1）和24小时测量的肌酐清除率（mCl），评估服用丙戊酸（VPA）和左乙拉西坦（LEV）的患者的肾小管和肾小球功能。
2023年1月至2024年1月期间，在安卡拉培训与研究医院对51例癫痫患者进行了这项前瞻性病例对照研究。排除使用多种AEDs的个体、数据不完整的个体、卧床患者、合并症（高血压、肥胖）患者或使用类固醇或其他药物的患者。参与者服用VPA或LEV至少六个月。16名年龄和性别匹配的健康儿童作为对照组。采集血样以及24小时尿液样本，测量NAG、KIM-1和mClcr。
VPA组、LEV组和对照组分别有30例、21例和16例患者。VPA组的尿pH值（6.1±0.7）和mCl水平（173.4±48.0）高于LEV组（5.6±0.5，149.7±39.1）和对照组（5.6±0.6，130.6±30.6）。LEV组和对照组之间的尿pH值和mCl水平无显著差异。VPA组、LEV组和对照组在24小时尿NAG、KIM-1、NAG/肌酐和KIM-1/肌酐水平方面未观察到统计学显著差异。mCl水平与治疗持续时间或血清药物水平之间在Spearman相关系数上无显著关联。
我们在癫痫儿童中发现了与VPA相关的肾小球高滤过。我们未观察到服用VPA或LEV的患者出现肾小管功能障碍。
