Plasma homocysteine and B vitamins levels in Nigerian children with nephrotic syndrome

Abstract

IntroductionAvailable data on plasma homocysteine level in patients with nephrotic syndrome (NS) are controversial with increased, decreased and unchanged values reported. Therefore, plasma homocysteine and serum B vitamins in Nigerian children with NS were assessed in this studyMethodsFasting blood samples were analysed for plasma homocysteine, serum folate and B vitamins in 42 children with NS and 42 age and sex-matched healthy controls in this case control study. Data were compared between NS and control using t test and Chi square. Relationships were tested with regression analysis with p set at 0.05.ResultsPrevalence of hyperhomocysteinaemia, low folate and cyanocobalamin in NS was 57.1%, 14.3% and 9.5% respectively. The mean homocysteine level was significantly higher in NS than control (11.3±2.6µmol/L versus 5.5±2.3µmol/L). Also, NS had lower folate and cyanocobalamin than control: 9.1±3.9ng/mL versus 11.2±3.1ng/dL and 268.5±95.7pg/mL versus 316±117.2pg/mL respectively. Weak but significant correlation between homocysteine and serum albumin (r = 0.347), folate (r = -0.607) and vitamin B12 (r = -0.185) were found in the NS group. Significant relationship was also found between homocysteine and vitamin B12 (ß = -0.64, 95% CI = -1.20, -0.08) after controlling for folate and vitamin B6 levels.ConclusionClinically important hyperhomocysteinaemia and low B vitamins occur in Nigerian children with nephrotic syndrome. This data suggest that potential usefulness of folate and vitamin B supplementation for reducing high homocysteine levels in nephrotic syndrome need to be further investigated

Homocysteine: Its Possible Emerging Role in At-Risk Population Groups

“…Inversely, folate levels were significantly lower (p < 0.01) in children affected by chronic renal failure (9.9 nmol/L) than in controls (13.5 nmol/L). The authors [110] found a higher prevalence of HHcy in dialyzed children than in nondialyzed patients (87% vs. 35%), and higher levels of HHcy in dialyzed children with MTHFR mutations (28.5 µmol/L) compared to nondialyzed patients with the mutation (10.7 µmol/L p < 0.002). Child patients (n = 12, aged 11.0 ± 3.5) with acute glomerulonephritis had higher Hcy levels (from 9.4 ± 3.3 to 13.5 ± 2.8 µmol/L) compared to controls (n = 15, 8.4 ± 2.4 µmol/L) and lower vitamin B6 and RBC folate levels (p < 0.01) [104].…”

“…HHCy in renal diseases shows a similar pattern to atherosclerosis, i.e., production of lipid-laden macrophage, presence of cholesterol and cholesterol ester, intima thickening, elastic lamina disruption, and luminal platelet accumulation [108,109]. Nephrotic syndrome (NS), a common pediatric kidney disease, is associated with HHCy due to inhibition of the homocysteine remethylation process or disruption in cysteine clearance [110]. Most NS patients are resistant to steroid treatments and have evolved into focal segmental glomerulosclerosis (FSGS) due to the pathogenic effect of HHcy, which causes podocyte injury and glomerulosclerosis [111,112].…”

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

“…However, we can infer that this abnormal increase may have been a reactional increase related to steroid use to treat NS, similar to the treatment of polymyalgia rheumatica [30]. After the use of vitamin B6, B12 and folic acid in the same patient group, the homocysteine concentrations decreased again [30,31]. Although another study showed that homocysteine concentrations were low during the proteinuria phase, they normalized during remission at 12 weeks and 1 year.…”

Relationship between serum zinc and homocysteine in children with nephrotic syndrome

“…Similarly, a previous study showed an increase in Hcy levels and decreased vitamin B12 levels in 42 children with NS in Nigeria. 9 Hyperhomocysteinemia in NS patients was suggested to be associated with an inhibition of the homocysteine remethylation process or disruption in cysteine clearance. 9 The normal homocysteine value in adults is 5-15 µmol/L, but there is no consensus on normal levels in children.…”

“…9 Hyperhomocysteinemia in NS patients was suggested to be associated with an inhibition of the homocysteine remethylation process or disruption in cysteine clearance. 9 The normal homocysteine value in adults is 5-15 µmol/L, but there is no consensus on normal levels in children. 10 Naseri et al in his study on Hhcy in children and young adults on dialysis, defined it in children by age: >8.3 µmol/L for children aged 2-10 years, >10.3 µmol/L for children aged 10-15 years, and >11.3 µmol/L for children aged 15-18 years.…”