Effects of Alkaline Phosphatase on Renal Function in Septic Patients
Effects of Alkaline Phosphatase on Renal Function in Septic Patients
Septic shock is the most common cause of death in patients requiring intensive care. The
 kidney is one of the first organs to fail, stressing the importance to search for clinical
 interventions that may protect the kidneys during sepsis.

 Alkaline phosphatase functions as a host defence molecule and is present in many cells and
 organs (e.g. intestine, placenta, liver, kidney and bone). Alkaline phosphatase has a dual
 mode of action. First, it binds to and, subsequently, dephosphorylates lipopolysaccharide
 (LPS). Second, the enzymatic reaction product monophosphoryl-LPS is a non-toxic substance for
 mammals which acts as a partial antagonist on the LPS receptor complex. In several animal
 studies, administration of alkaline phosphatase attenuates the inflammatory response and
 reduces mortality.

 It is unknown whether these results can be extrapolated to septic patients . We studied the
 effects of alkaline phosphatse administration on kidney damage and function in patients with
 severe sepsis or septic shock.
Inclusion Criteria:

 -  Written informed consent

 -  Proven or suspected Gram-negative bacterial infection

 -  Two out of four Systemic Inflammatory Response Syndrome (SIRS) criteria existing for
 less than 24 h

 -  Acute onset of end-organ dysfunction in the preceding 12 h

 Exclusion Criteria:

 -  Prior therapy with alkaline phosphatase

 -  Known allergy for cow milk

 -  Probable death within 24 h

 -  Chronic renal failure requiring hemodialysis or peritoneal dialysis

 -  Acute pancreatitis with no established source of infection

 -  HIV seropositive

 -  Pregnant or lactating

 -  Confirmed Gram-positive or fungal sepsis

 -  Treatment with immunosuppressants including high doses of glucocorticosteroids