Increased D-glucaric acid excretion in children with renal disease.

In 85 infants and children, non-specific microsomal enzyme activity was assessed by measuring the urinary D-glucaric acid excretion. In patients with renal disease of various etiology, a highly significant increase in the D-glucaric acid excretion was observed at any early stage of the illness. This change was most marked in patients suffering from tubulopthy and pyelonephritis. Excretion of D-glucaric acid was significantly more pronounced in patients with renal disease than in controls, even in those groups of infants and children who were given enzyme-inducing drugs. As an explanation for the elevation of urinary D-glucaric acid levels in patients with mild renal disease, the possibility and biochemical mechanism of an induction of drug metabolizing enzymes are discussed and some therapeutic conclusions are drawn.