Interference with the Jaffé method for creatinine following 5-aminolevulinic acid administration

Harry Quon, Craig E. Grossman, Rebecca King, Mary Putt, Keri Donaldson, Larry Kricka, Jarod Finlay, Timothy Zhu, Andrea Dimofte, Kelly Malloy, Keith A. Cengel, Theresa M. Busch

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: The photosensitizer pro-drug 5-aminolevulinic acid (5-ALA) has been administered systemically for photodynamic therapy. Although several toxicities have been reported, nephrotoxicity has never been observed. Materials and methods: Patients with head and neck mucosal dysplasia have been treated on a phase 1 study of escalating light doses in combination with 60. mg/kg of oral 5-ALA. Serum creatinine was measured with the modified Jaffe method or an enzymatic method in the first 24. h after 5-ALA. Interference by 5-ALA, as well as by its photosensitizing product protoporphyrin IX, was assessed. Results: Among 11 subjects enrolled to date, 9 of 11 had blood chemistries collected within the first 5. h with 7 demonstrating significant grade 3 creatinine elevations (p=0.030). There was no additional evidence of compromised renal function or increased PDT-induced mucositis. Creatinine levels measured by the Jaffe assay increased linearly as a function of the ex vivo addition of ALA (p< 0.0001). The exogenous addition of PpIX did not alter creatinine levels. ALA did not interfere with creatinine levels as measured by an enzymatic assay. A total of 4 of the 11 subjects had creatinine levels prospectively measured by both the Jaffe and the enzymatic assays. Only the Jaffe method demonstrated significant elevations as a function of time after ALA administration. Conclusions: The transient increase in creatinine after systematic ALA can be attributed, in part, if not entirely, to interference of ALA in the Jaffe reaction. Alternative assays should be employed in situations calling for monitoring of kidney function after systemic ALA.

Original languageEnglish (US)
Pages (from-to)268-274
Number of pages7
JournalPhotodiagnosis and Photodynamic Therapy
Volume7
Issue number4
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

Fingerprint

Aminolevulinic Acid
Creatinine
Enzyme Assays
Kidney
Mucositis
Photosensitizing Agents
Photochemotherapy
Prodrugs
Neck
Head
Light
Serum

Keywords

  • Creatinine
  • Jaffe method
  • Levulan
  • Photodynamic therapy
  • Side effect

ASJC Scopus subject areas

  • Biophysics
  • Oncology
  • Dermatology
  • Pharmacology (medical)

Cite this

Interference with the Jaffé method for creatinine following 5-aminolevulinic acid administration. / Quon, Harry; Grossman, Craig E.; King, Rebecca; Putt, Mary; Donaldson, Keri; Kricka, Larry; Finlay, Jarod; Zhu, Timothy; Dimofte, Andrea; Malloy, Kelly; Cengel, Keith A.; Busch, Theresa M.

In: Photodiagnosis and Photodynamic Therapy, Vol. 7, No. 4, 01.12.2010, p. 268-274.

Research output: Contribution to journalArticle

Quon, H, Grossman, CE, King, R, Putt, M, Donaldson, K, Kricka, L, Finlay, J, Zhu, T, Dimofte, A, Malloy, K, Cengel, KA & Busch, TM 2010, 'Interference with the Jaffé method for creatinine following 5-aminolevulinic acid administration', Photodiagnosis and Photodynamic Therapy, vol. 7, no. 4, pp. 268-274. https://doi.org/10.1016/j.pdpdt.2010.07.008
Quon, Harry ; Grossman, Craig E. ; King, Rebecca ; Putt, Mary ; Donaldson, Keri ; Kricka, Larry ; Finlay, Jarod ; Zhu, Timothy ; Dimofte, Andrea ; Malloy, Kelly ; Cengel, Keith A. ; Busch, Theresa M. / Interference with the Jaffé method for creatinine following 5-aminolevulinic acid administration. In: Photodiagnosis and Photodynamic Therapy. 2010 ; Vol. 7, No. 4. pp. 268-274.
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abstract = "Background: The photosensitizer pro-drug 5-aminolevulinic acid (5-ALA) has been administered systemically for photodynamic therapy. Although several toxicities have been reported, nephrotoxicity has never been observed. Materials and methods: Patients with head and neck mucosal dysplasia have been treated on a phase 1 study of escalating light doses in combination with 60. mg/kg of oral 5-ALA. Serum creatinine was measured with the modified Jaffe method or an enzymatic method in the first 24. h after 5-ALA. Interference by 5-ALA, as well as by its photosensitizing product protoporphyrin IX, was assessed. Results: Among 11 subjects enrolled to date, 9 of 11 had blood chemistries collected within the first 5. h with 7 demonstrating significant grade 3 creatinine elevations (p=0.030). There was no additional evidence of compromised renal function or increased PDT-induced mucositis. Creatinine levels measured by the Jaffe assay increased linearly as a function of the ex vivo addition of ALA (p< 0.0001). The exogenous addition of PpIX did not alter creatinine levels. ALA did not interfere with creatinine levels as measured by an enzymatic assay. A total of 4 of the 11 subjects had creatinine levels prospectively measured by both the Jaffe and the enzymatic assays. Only the Jaffe method demonstrated significant elevations as a function of time after ALA administration. Conclusions: The transient increase in creatinine after systematic ALA can be attributed, in part, if not entirely, to interference of ALA in the Jaffe reaction. Alternative assays should be employed in situations calling for monitoring of kidney function after systemic ALA.",
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AU - Quon, Harry

AU - Grossman, Craig E.

AU - King, Rebecca

AU - Putt, Mary

AU - Donaldson, Keri

AU - Kricka, Larry

AU - Finlay, Jarod

AU - Zhu, Timothy

AU - Dimofte, Andrea

AU - Malloy, Kelly

AU - Cengel, Keith A.

AU - Busch, Theresa M.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Background: The photosensitizer pro-drug 5-aminolevulinic acid (5-ALA) has been administered systemically for photodynamic therapy. Although several toxicities have been reported, nephrotoxicity has never been observed. Materials and methods: Patients with head and neck mucosal dysplasia have been treated on a phase 1 study of escalating light doses in combination with 60. mg/kg of oral 5-ALA. Serum creatinine was measured with the modified Jaffe method or an enzymatic method in the first 24. h after 5-ALA. Interference by 5-ALA, as well as by its photosensitizing product protoporphyrin IX, was assessed. Results: Among 11 subjects enrolled to date, 9 of 11 had blood chemistries collected within the first 5. h with 7 demonstrating significant grade 3 creatinine elevations (p=0.030). There was no additional evidence of compromised renal function or increased PDT-induced mucositis. Creatinine levels measured by the Jaffe assay increased linearly as a function of the ex vivo addition of ALA (p< 0.0001). The exogenous addition of PpIX did not alter creatinine levels. ALA did not interfere with creatinine levels as measured by an enzymatic assay. A total of 4 of the 11 subjects had creatinine levels prospectively measured by both the Jaffe and the enzymatic assays. Only the Jaffe method demonstrated significant elevations as a function of time after ALA administration. Conclusions: The transient increase in creatinine after systematic ALA can be attributed, in part, if not entirely, to interference of ALA in the Jaffe reaction. Alternative assays should be employed in situations calling for monitoring of kidney function after systemic ALA.

AB - Background: The photosensitizer pro-drug 5-aminolevulinic acid (5-ALA) has been administered systemically for photodynamic therapy. Although several toxicities have been reported, nephrotoxicity has never been observed. Materials and methods: Patients with head and neck mucosal dysplasia have been treated on a phase 1 study of escalating light doses in combination with 60. mg/kg of oral 5-ALA. Serum creatinine was measured with the modified Jaffe method or an enzymatic method in the first 24. h after 5-ALA. Interference by 5-ALA, as well as by its photosensitizing product protoporphyrin IX, was assessed. Results: Among 11 subjects enrolled to date, 9 of 11 had blood chemistries collected within the first 5. h with 7 demonstrating significant grade 3 creatinine elevations (p=0.030). There was no additional evidence of compromised renal function or increased PDT-induced mucositis. Creatinine levels measured by the Jaffe assay increased linearly as a function of the ex vivo addition of ALA (p< 0.0001). The exogenous addition of PpIX did not alter creatinine levels. ALA did not interfere with creatinine levels as measured by an enzymatic assay. A total of 4 of the 11 subjects had creatinine levels prospectively measured by both the Jaffe and the enzymatic assays. Only the Jaffe method demonstrated significant elevations as a function of time after ALA administration. Conclusions: The transient increase in creatinine after systematic ALA can be attributed, in part, if not entirely, to interference of ALA in the Jaffe reaction. Alternative assays should be employed in situations calling for monitoring of kidney function after systemic ALA.

KW - Creatinine

KW - Jaffe method

KW - Levulan

KW - Photodynamic therapy

KW - Side effect

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