Abnormalities of homocysteine and B vitamins in the nephrotic syndrome.
BACKGROUND
The nephrotic syndrome is associated with heightened risk for arterial and venous thrombosis. Multiple derangements of hemostasis and acquired risk factors such as hyperlipidemia and hypertension contribute to this risk. The prevalence in the nephrotic syndrome of high circulating levels of homocysteine and of low levels of the B vitamins that are involved in its metabolism, which may play a role in thrombosis, is not well defined.


METHODS
In 84 patients with nephrotic syndrome and 84 sex- and age-matched controls, hemostasis variables and the circulating levels of total homocysteine (tHcy), vitamin B(6), B(12) and folates were measured.


RESULTS
tHcy levels were higher, vitamin B(6) and vitamin B(12) levels were lower in nephrotic patients than in controls. The association of low vitamin B(6) levels with the nephrotic syndrome was independent of any other alteration associated with the disease. Eighty-two percent of patients with the nephrotic syndrome had vitamin B(6) levels falling in the lowest quartile of the normal distribution. Antithrombin deficiency, factor V Leiden, antiphospholipid antibodies, hypertension, dyslipidemia, were more frequent in patients with the nephrotic syndrome than in controls.


CONCLUSIONS
Patients with the nephrotic syndrome have multiple risk factors for thrombosis. We report that they frequently have low circulating levels of vitamin B(6), which associate with a heightened risk for venous and arterial thrombosis.
Podda
Gian Marco
GM
Centro Emofilia e Trombosi "Angelo Bianchi Bonomi", Dipartmento di Medicina Interna e Dermatologia, Fondazione I.R.C.C.S. Ospedale Maggiore, Mangiagalli e Regina Elena, Università di Milano, Italy.
Lussana
Federico
F
Moroni
Gabriella
G
Faioni
Elena M
EM
Lombardi
Rossana
R
Fontana
Gessica
G
Ponticelli
Claudio
C
Maioli
Claudio
C
Cattaneo
Marco
M
D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000737:chemistry; D000991:Antithrombins / Q000172:deficiency; D005165:Factor V / Q000378:metabolism; D005260:Female; D005492:Folic Acid / Q000378:metabolism; D006710:Homocysteine / Q000378:metabolism*; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis; D006973:Hypertension / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000378:metabolism / Q000473:pathology*; D012306:Risk; D012307:Risk Factors; D014805:Vitamin B 12 / Q000378:metabolism; D025101:Vitamin B 6 / Q000378:metabolism; D014803:Vitamin B Complex / Q000378:metabolism*
D017152:Antibodies, Antiphospholipid; D000991:Antithrombins; C095381:factor V Leiden; D006710:Homocysteine; D014803:Vitamin B Complex; D025101:Vitamin B 6; D005165:Factor V; D005492:Folic Acid; D014805:Vitamin B 12