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NDT Advance Access originally published online on May 5, 2004
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Nephrol Dial Transplant (2004) 19: 1767-1773
Nephrol Dial Transplant Vol. 19 No. 7 © ERA-EDTA 2004; all rights reserved


Original Article

Urinary L-lactate excretion is increased in renal Fanconi syndrome

Arumugavelu Thirumurugan1, Andrew Thewles2, Rodney D. Gilbert3, Sally-Anne Hulton1, David V. Milford1, Christopher J. Lote2 and C. Mark Taylor1

1 Department of Nephrology, Birmingham Children's Hospital, Birmingham, 2 Division of Medical Science, University of Birmingham, Birmingham and 3 Department of Paediatric Nephrology, Southampton General Hospital, Southampton, UK

Correspondence and offprint requests to: Dr C. Mark Taylor, Department of Nephrology, Birmingham Children's Hospital, Birmingham B4 6NH, UK. Email: cm.taylor{at}bch.nhs.uk

Background. Measurement of L-lactate in body fluids is an established clinical tool to identify disorders of cellular respiration. However, there is very little known about the clinical value of urinary lactate measurements. We investigated urinary lactate excretion in children with renal Fanconi syndrome.

Methods. Freshly voided urine samples were obtained from children with Fanconi syndrome and controls both with and without renal disease. Urine lactate was estimated by conversion to pyruvate in the presence of lactate dehydrogenase and NAD. The NADH produced was measured photometrically. Urine lactate was factored for urine creatinine.

Results. Children with Fanconi syndrome had a significantly higher urine lactate/creatinine ratio [mean: 84 x 10–2 mmol/mmol; 95% confidence interval (CI): 40.8–127.1 x 10–2 mmol/mmol] than healthy controls (mean: 1.3 x 10–2 mmol/mmol; CI: 1.1–1.5 x 10–2 mmol/ mmol) and those with a variety of renal diseases (mean: 3.1 x 10–2 mmol/mmol; CI: 1.8–4.5 x 10–2 mmol/mmol).

Conclusions. Urinary lactate is increased in Fanconi syndrome. The increase is likely to be due to reduced lactate co-transport in the proximal tubule. Urinary lactate/creatinine has clinical utility as a sensitive test of disordered proximal renal tubular function.

Keywords: Fanconi syndrome; lactate co-transport; proximal tubule disorders; urinary lactate cystinosis


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