A prospective study of serum concentrations of leptin, homocysteine and insulin resistance in children with steroid-sensitive nephrotic syndrome

Abstract

To measure serum leptin, homocysteine concentrations and insulin resistance in active and remission stages of children with nephrotic syndrome (NS) and to investigate their role in NS pathogenesis. Methods: A total of 70 children were included in the study, 40 patients who had been diagnosed with NS and 30 healthy patients were control. Changes in plasma concentration of the serum homocysteine, leptin, and insulin were measured and compared with the other parameters in the groups. Results: Serum leptin concentrations in active phase were lower than the remission phase (1.48 ± 0.09 ng/dl, 1.84 ± 1.64 ng/ml, p<0.05). Also, serum homocysteine concentrations in NS group during the active phase were lower than the remission phase and the control group (6.45±2.54 ng/dl, 9.35±2.99 ng/ml, 7.76± 1.97 ng/ml, p<0.05). The serum fasting insulin concentrations and homeostatic model assessment for insulin resistance (HOMA-IR) values of remission phase were significantly higher than those of active phase (p<0.05). A positive relationship was found between the homocysteine concentrations and the body mass index of the patient; whereas, a negative relationship was detected between erythrocyte sedimentation rate (ESR), and the LDL-cholesterol concentrations (p<0.05). ESR was found as the only factor associated with lower concentrations of homocysteine during the active phase (r:-0.592, p<0.05). Conclusion:In this study, we demonstrated that serum leptin and homocysteine concentrations decreased in active phase and increased in remission phase in children with NS. Insulin resistance could also develop as a result of steroid use in a short period of time in these patients.

Pediatric nephrotic syndrome: The interplay of oxidative stress and inflammation

“…However, studies have reported conflicting results regarding the level of serum leptin in the acute phase of NS compared with the remission phase levels. Some studies found lower (25,26,67), and others found unchanged (23,68) or higher (69) levels of leptin in the acute phase of NS compared with the remission phase. Our results are consistent with those studies that found lower levels of leptin during the acute phase of NS.…”

“…Several studies have shown that a high level of leptin concentration is associated with CKD progression and its complications (22). To date, studies regarding leptin in pediatric patients with NS have reported inconsistent results, and its role in this condition remains unclear (23)(24)(25)(26). Programmed cell death ligand 1 (PD-L1) is a transmembrane protein expressed on immune, epithelial, endothelial cells and various other cell types, and its interaction with PD-1 plays a crucial role in maintaining immune tolerance and regulating immune responses (27).…”