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Pediatr Nephrol (2014) 29:11311138 DOI 10.1007/s00467-013-2512-x
REVIEW
The effects of sodium valproate on the renal function of children with epilepsy
Mark Jonathan Knights & Eric Finlay
Received: 15 March 2013 /Revised: 27 April 2013 /Accepted: 8 May 2013 /Published online: 30 May 2013 # IPNA 2013
Abstract Sodium valproate is one of the most commonly used drugs to treat epilepsy. However, there is growing evidence that valproate can cause renal tubular injury in children, and there are increasing reports of valproate-induced Fanconis syndrome where the renal tubules lose their ability to reabsorb electrolytes, urea, glucose and protein. In this review article we attempt to bring together all of the studies conducted to date on the effects of valproate on renal function in epileptic children. The research is generally considered in two themes; the first comprises studies which indicate subclinical tubular injury measured by renal enzymes such as N-acetyl--D-glucosaminidase (NAG), and the second comprises clinical reports where Fanconis syndrome has occurred. This article goes on to analyse the current data and draws on recurring patterns to suggest that a specific subpopulation of severely disabled epileptic children may benefit hugely from the close monitoring of enzymes which are indicative of renal tubular injury, particularly NAG or in the very least periodical urinalysis.
Keywords Paediatrics . Renal tubular dysfunction .
N-acetyl--D-glucosaminidase . Fanconis syndrome
Introduction
Sodium valproate is the sodium salt of valproic acid (VPA) and is used clinically as an anticonvulsant and mood-stabilising
drug. The main side effects of sodium valproate treatment include nausea, gastric irritation, diarrhoea, hepatic and pancreatic dysfunction, weight gain and thrombocytopenia. In the past two decades a steadily increasing amount of evidence has linked epileptic children who are being treated with valproate and renal tubular dysfunction. There is also growing evidence that a group of sensitive renal markers, particularly N-acetyl--
D-glucosaminidase (NAG), can be used not only to indicate valproate-induced tubular dysfunction but perhaps also to monitor it. This monitoring requirement is becoming more and more necessary as the number of reported cases of valproate-induced Fanconis syndrome (a disease of the proximal renal tubules in which urea, electrolytes, glucose and amino acids are passed into the urine instead of being reabsorbed) is increasing, specifically in a subpopulation of epileptic children who are severely...