Vol. 6, Issue 1, Part A (2024)

Background: The central nervous system (CNS) is impacted by the condition known as epilepsy. It is one of the most common neurologic diseases in children. Children (those less than the age of 16) are reported to have an incidence of epilepsy that ranges from 41/100000 to 187/100000. The purpose of this work was to measure urinary N-acetyl-Beta-D- glucosaminidase NAG excretion in children with epilepsy, treated with sodium valproate monotherapy to evaluate the impacts of sodium valproate on renal tubular functions.
Methods: This cross-sectional study was performed on 50 children with epilepsy treated with sodium valproate monotherapy for not less than six months or more, with generalized or partial seizures or partial seizure with secondary generalization and 30 children who were physically healthy and well-fed were chosen. As the age-matched control group. All patients were subjected to neuro-imaging and electroencephalogram study (MRI and EEG), routine laboratory studies and specific investigations (Urinary N-Acetyl-βeta-D-glucosaminidase enzyme assay). 
Results: A substantial positive association was existed among the treatment duration and the urinary NAG index. Increased duration of treatment with sodium valproate is associated with increased urinary NAG index. (r=0.309, P=0.029). The mean urinary NAG and urinary NAG index in children with epilepsy were substantially greater than the control children. (P-value < 0.001).
Conclusion: Sodium valproate has significant time-related adverse effect on renal functions. It induces histopathological alterations and oxidative stress in tissues of kidney causing tubulointerstitial nephritis. Also, the capacity of the renal tubules for reabsorbing electrolytes, protein, glucose, and urea is being lost in cases of Fanconi syndrome produced by valproate, which is becoming more prevalent. Increased urinary NAG and urinary NAG index in epileptic children received sodium valproate treatment is an early indicator of renal impairment. There is substantial potential association among urinary NAG and treatment duration, The increase in urinary NAG excretion becomes greater as the duration increases.