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We studied the effects of epalrestat, a specific inhibitor of aldose reductase, on renal sorbitol accumulation and the resulting urinary enzyme excretion in hyperglycaemic rats.    The activities of proximal tubule-derived enzymes such as N-acetyl- β-D-glucosaminidase (NAG), alanine aminopeptidase (AAP), γ-glutamyltranspeptidase (GGT) and dipeptidyl aminopeptidase IV (DAPIV) in urine were determined in five groups of male Wistar rats (each n=7): (a) 0·9% saline-loaded, (b) 10% glucose-loaded, (c) 10% glucose-loaded with epalrestat pretreatment, (d) 10% mannitol-loaded and (e) 10% mannitol-loaded with epalrestat pretreatment. Epalrestat was given mixed in chow at a dose of 50mg/kg body weight.    Urinary NAG, AAP, GGT and DAPIV activities were significantly increased ( P&lt;0·005, P&lt;0·05, P&lt;0·01, P&lt;0·01, respectively) by the induction of hyperglycaemia. In contrast, enzyme excretion was not increased in the mannitol- or saline-loaded groups. Pre-treatment with epalrestat completely prevented the increased urinary excretion of NAG, AAP and GGT. At the end of the infusion study, renal cortical glucose concentrations of the glucose-loaded groups with and without epalrestat pretreatment were approximately fivefold higher than those of the mannitol- or saline-loaded groups ( P&lt;0·005 each). Renal cortical sorbitol concentrations of the glucose-loaded group was also approximately twofold higher than those of the mannitol- or saline-loaded groups ( P&lt;0·01 each). However, in the group that received both glucose and epalrestat, renal cortical sorbitol concentration was not increased.    These results suggest that accumulation of intracellular sorbitol leads to proximal tubular cell dysfunction and abnormal enzymuria.

Effects of renal sorbitol accumulation on urinary excretion of enzymes in hyperglycaemic rats