The Role of Monocyte to High-Density Lipoprotein Cholesterol Ratio in Predicting the Severity of Proteinuria and Renal Dysfunction in Primary Nephrotic Syndrome.

Fatma Yılmaz Aydın,Eren Eynel,Emre Aydın,Enver Yüksel,Hasan Ince,İdris Oruç

doi:10.7759/cureus.20345

Abstract

Introduction: Monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) has emerged as a novel marker of endothelial injury, inflammation, and oxidative stress. This study aimed to investigate the effect of MHR on primary nephrotic syndrome (NS) and its relationship with the severity of proteinuria.Methods: This study enrolled 161 patients newly diagnosed with primary NS and 100 healthy individuals. Demographic characteristics of the patients, primary NS diagnosis, basal laboratory parameters, the amount of 24-hour urinary protein excretion, and MHR were recorded. The groups were compared regarding these parameters.Results: MHR was significantly higher in patients with primary NS compared with the healthy group (12.89 ± 4.86 and 9.71 ± 2.30, respectively; p < 0.001). There was no difference between the groups in terms of age and sex. The amount of protein in the 24-hour urine in patients with a diagnosis of primary NS was 6.91 ± 3.73 g/day. The correlation analysis showed a positive correlation between MHR and the amount of proteinuria (r = 0.519, p < 0.001) and creatinine level (r = 0.167, p = 0.034). The multivariate regression analysis found that the severity of proteinuria was independently correlated to MHR (p < 0.001). According to the receiver operating characteristic curve analysis, the optimal cut-off level for MHR in NS was 10.08 (area under the curve of 0.704, sensitivity of 68%, and a specificity of 62%).Conclusion: Our study is the first to compare the severity of proteinuria and renal functions with MHR in patients with primary NS. We believe that MHR can be used as a biomarker to determine inflammation, endothelial injury, and the level of oxidative stress, and may be useful to predict prognosis in patients with primary NS.

Highlights

Monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) has emerged as a novel marker of endothelial injury, inflammation, and oxidative stress
Our study is the first to compare the severity of proteinuria and renal functions with monocyte to HDL cholesterol ratio (MHR) in patients with primary nephrotic syndrome (NS)
An analysis of the laboratory parameters at the time of diagnosis in the primary NS group showed that the mean amount of 24-hour proteinuria was 6.91 ± 3.73, mean albumin level was 2.81 ± 0.65, mean low-density lipoprotein (LDL) level was 156.39 ± 87.15, mean HDL level was 43.90 ± 10.08, and mean monocyte count was 544.04 ± 188.61

Summary

Introduction

Monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) has emerged as a novel marker of endothelial injury, inflammation, and oxidative stress. These monocytes and macrophages phagocytes oxidize low-density lipoprotein (LDL) cholesterol molecules and form foam cells, thereby inducing the release of pro-inflammatory and pro-oxidant cytokines. High-density lipoprotein (HDL) cholesterol, on the other hand, reduces monocyte activation and protects endothelium against the detrimental effects of oxidized LDL cholesterol particles. HDL prevents the expression of adhesion molecules and causes nitric oxide release, and induces vasodilation. Due to these properties, it has anti-inflammatory and anti-oxidant properties. An increased count of pro-inflammatory monocytes and a reduced level of anti-inflammatory HDL cholesterol have been considered novel markers of inflammation. As a result of these studies, the monocyte to HDL cholesterol ratio (MHR) has emerged as a novel marker for

Objectives

Methods

Results

Discussion

Conclusion