DETERMINING THE RELATIONSHIP BETWEEN HOMOCYSTEINEMIA AND BIOMARKERS OF INFLAMMATION, OXIDATIVE STRESS AND FUNCTIONAL KIDNEY STATUS IN PATIENTS WITH DIABETIC NEPHROPATHY

Background: One of the leading causes of terminal renal failure is diabetic nephropathy. The aim of this study was to determine the relationship between homocysteine levels and the biomarkers of renal function, inflammation and oxidative stress, as well as the incidence of macrovascular complications in patients with diabetic nephropathy. Methods: Sixty-four patients with diabetic nephropathy were included in this study. They were divided according to their homocysteine levels into two groups: hyperhomocysteinemic (HHcy, n=47) and normohomocysteinemic patients (NHCy, n=17). The results were compared to a control group (n=20) with normal renal function and without diabetes. Besides homocysteine, cystatine C, creatinine, urea, albuminuria, creatinine clearance, lipid status parameters, apolipoprotein A-I and B, lipoprotein (a), CRP fibrinogen, oxidative LDL were determined using appropriate methods. The incidence of macrovascular diabetic complications was also determined. Results: The results indicate that the level of renal dysfunction is greater in HHcy than in NHcy patients (p<0.05). In HHcy patients levels of oxLDL were also higher compared to NHcy patients (119.3 +/- 140.4 vs. 71.4 +/- 50.8 ng/mL, p<0.05) as well as fibrinogen levels (4.3 +/- 1.3 vs. 3.7 +/- 0.8 g/L, p<0.05). The incidence of macrovascular complications is more frequent in HHcy than in NHcy patients (55.3. vs. 35.3 %, p>0.05), and in patients with macroalbuminuria compared to patients with microalbuminuria (65% vs. 39%, p<0.05). Conclusions: It can be concluded that HHcy is significantly present in patients with diabetic nephropathy, especially if there is greater reduction of renal function. Besides that, significantly higher concentrations of inflammatory (fibrinogen) and oxidative stress (oxLDL) markers were present in HHcy patients with diabetic nephropathy compared to NHcy patients. Therefore in diabetic nephropathy patients it is useful to regularly monitor the levels of homocysteine, as well as inflammatory and markers of oxidative stress.