Abstract
Homocysteine (Hcy) is an intermediate product of methionine formed by its demethylation. Hcy can be metabolized via remethylation to methionine or transsulfuration to cysteine which is dependent on several enzymes and cofactors. It is deleterious to blood vessel including glomeruli. Kidney is a major organ that metabolizes Hcy. More than 80% of patients with chronic renal disease develop hyperhomocysteinemia (hHcy). Accessible data of plasma Hcy in nephritic syndrome (NS) patients are controversial with increased, decreased and unchanged values reported. In renal patients, plasma Hcy concentration can be reduced by administration of folic acid. Absolute or relative deficiencies of folate, vitamin B6, or vitamin B12 may also play a role. Therefore, plasma Hcy, folic acid, vitamin B6, and vitamin B12 in children with acute glomerulonephritis (AGN) were accessed in this study. Hcy, folic acid vitamin B12, B6 and renal function such as blood urea nitrogen (BUN), creatinine (Cr) were analyzed 12 pediatric patients with AGN and 15 age and sex matched healthy children served as controls. The results revealed that a significant increase in plasma Hcy in children with acute AGN when compared with controls. For simple regression analysis, Hcy was positively correlated with BUN, Cr, ferritin and uric acid but negatively correlated with serum glutathione. This research indicated hHcy suggests enhanced risks for inflammation and endothelial injury, which lead to kidney disease. Folic acid has also been shown to improve endothelial function, suggesting an alternative explanation for the effect of folic acid on endothelial function. Careful considerations of not only dietary measures are necessary but also folate and vitamin B supplementation for reducing hHcy in AGN need to be investigated.
Highlights
Homocysteine (Hcy) is an intermediate product of methionine formed by its demethylation
Hcy can be metabolized via remethylation to methionine or transsulfuration to cysteine which is dependent on several enzymes and cofactors
Data obtained from the United States third National Health and Nutrition Survey between 1991-1994 showed that among adults with moderate to severe loss of renal function from creatinine clearance (Ccr) calculated from the Cockroft-Gault formula, the odd ratio (OR) for elevated Hcy associated with Ccr ≤ 50 ml/min/1.73 m2 compared to Ccr > 80 ml/min/1.73 m2 was 9.1 in men and 2.9 in women
Summary
Homocysteine (Hcy) is an intermediate product of methionine formed by its demethylation. Hcy is metabolized in the liver and kidney. Normal kidney plays an important role in maintaining the level of Hcy in the circulation through filtration. Hcy level increases as renal function declines and processes to end-stage renal disease (ESRD) with the majority (>85%) of patients experiencing mind-to-moderate hHcy [1]. Numerous studies confirm the strong and strikingly consistent inverse relationship between Hcy levels and renal function over a broad range of glomerular filtration rates (60 ml to 165 ml/min). Data obtained from the United States third National Health and Nutrition Survey between 1991-1994 showed that among adults with moderate to severe loss of renal function from creatinine clearance (Ccr) calculated from the Cockroft-Gault formula, the odd ratio (OR) for elevated Hcy associated with Ccr ≤ 50 ml/min/1.73 m2 compared to Ccr > 80 ml/min/1.73 m2 was 9.1 in men and 2.9 in women. With marginally subnormal renal function (Ccr 51 - 80 ml/min/1.73 m2) compared to normal renal function (Ccr > 80 ml/min/1.73 m2), the ORs were 1.3 in men and 1.2 in women [2]
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