Serum amino acid abnormalities in pediatric patients with chronic renal failure with and without history of thromboembolic manifestations

Mohamad A El Sawy,Mona M Zaki,Ihab Z El-Hakim,Mohamad E Mowafy,Heba S Al-Abd

doi:10.1016/j.ejmhg.2011.06.007

Mohamad A El Sawy, Mona M Zaki + Show 3 more

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https://doi.org/10.1016/j.ejmhg.2011.06.007

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Abstract

BackgroundPlasma amino acid concentrations have been reported to be abnormal in patients with chronic renal failure. l-Arginine has been used to improve endothelial function by increasing nitric oxide (NO) bioavailability.The present study aim at investigating the status of plasma amino acids in pediatric patients with chronic renal failure (CRF) on regular hemodialysis (HD) with and without history of thromboembolic manifestations. MethodsThe study included 21 hemodialysis patients subdivided into two groups (those with no history of thromboembolic manifestations and those with positive history of thromboembolic manifestations) The control group included 13 age and sex matched apparently healthy subjects, After careful history taking, clinical examination, the following laboratory investigations were performed: serum calcium, phosphate, albumin, and creatinine (for controls only), complete blood count (CBC) and serum amino acid analysis. ResultsHD patients had a significantly lower concentration of threonine, valine, methionine, leucine, tyrosine, phenylalanine and tryptophane than the control group (p=0.032, 0.020, 0.046, 0.011, 0.000, 0.022, and 0.004 respectively). There was no significant difference between HD patients and the control group as regard aspartic acid, serine, asparagine, glutamic acid, proline, glycine, alanine, cystine, isoleucine, lysine, histidine, and arginine. The mean serum l-arginine level was lower in 61.9% of HD patients than the mean of the controls with no significant difference. l-Arginine concentration was not significantly different between HD patients with and without history of thromboembolic manifestations. ConclusionSeveral abnormalities in amino acids were present in HD patients compared to controls. The mean serum l-arginine level was lower in 61.9% of HD patients than the mean of the controls with no significant difference. l-Arginine concentration was not significantly different between HD patients with and without history of thromboembolic manifestations. HD patients without history of thromboembolic manifestations had significantly lower glutamic acid concentrations and significantly higher phenylalanine concentrations than HD patients with history of thromboembolic manifestations.

Highlights

The uremic syndrome is a complex condition that results from an accumulation of multiple waste compounds, combined with failure of the endocrine and homeostatic functions of the kidney in end-stage chronic renal failure (CRF) patients [1].Malnutrition is a common pathological condition which exacerbates cardiovascular morbidity and mortality in chronic renal failure patients.The underlying mechanisms of malnutrition in CRF have not been completely clarified
The mean serum L-arginine level was lower in 61.9% of HD patients than the mean of the controls with no significant difference
There was no significant difference between HD patients and the control group (p = 0.267, 0.082, 0.807, and 0.266) as regard age, height, alkaline phosphatase and albumin (Table 1)

Summary

Introduction

The uremic syndrome is a complex condition that results from an accumulation of multiple waste compounds, combined with failure of the endocrine and homeostatic functions of the kidney in end-stage chronic renal failure (CRF) patients [1].Malnutrition is a common pathological condition which exacerbates cardiovascular morbidity and mortality in chronic renal failure patients.The underlying mechanisms of malnutrition in CRF have not been completely clarified. Protein metabolism changes with loss of renal function resulting in deterioration of nutritional status [2]. Levels of plasma and intracellular amino acids are significant early indicators of protein metabolism and nutritional status assessment [1,3]. Progressive loss of renal function generally results in increasing abnormalities; these changes in plasma amino acid concentrations were usually linear with reduction in glomerular filtration rate (GFR) [4]. Plasma amino acid concentrations have been reported to be abnormal in patients with chronic renal failure. The present study aim at investigating the status of plasma amino acids in pediatric patients with chronic renal failure (CRF) on regular hemodialysis (HD) with and without history of thromboembolic manifestations.

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