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the ratio between GSH and GSSG is held in dynamic balance depending on many factors including the tissue of interest, intracellular demand for conjugation reactions, intracellular demand for reducing power, extracellular demand for reducing potential, and the complex interplay between several regulatory enzymes including glutathione peroxidase (GPx), glutathione- S -transferase (GST) and -glutamyltransferase (GGT)

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Other signs of VAN include proteinuria (typically non-nephrotic range), hematuria, and leukocyturia, signaling possible renal inflammation

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