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Homocysteine in uremia

Alessandra F Perna1, Diego Ingrosso, Cinzia Lombardi

  • 1First Division of Nephrology/Department of Pediatrics, School of Medicine, Second University of Naples (SUN), Naples, Italy. alessandra.perna@unina2.it

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|March 4, 2003
PubMed

Insights

High homocysteine (HHcy) is a cardiovascular risk factor, especially in chronic renal failure (CRF). Its mechanisms and the impact of lowering HHcy on cardiovascular risk are under investigation.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Biochemistry

Background:

  • Hyperhomocysteinemia (HHcy) is an independent cardiovascular risk factor, potentially contributing to 20% of cardiovascular deaths.
  • HHcy prevalence is high in chronic renal failure (CRF) and uremia, though some patients remain normohomocysteinemic.

Purpose of the Study:

  • To investigate the causes and consequences of hyperhomocysteinemia in chronic renal failure.
  • To explore the mechanisms of homocysteine toxicity and potential interventions.

Main Methods:

  • Review of existing literature on hyperhomocysteinemia in CRF.
  • Analysis of homocysteine's toxic mechanisms, including oxidative stress and hypomethylation.
  • Discussion of proposed nutritional and pharmacological interventions.

Main Results:

  • Hyperhomocysteinemia is common in CRF, with its exact cause (renal vs. extrarenal metabolism, uremic toxins) under scrutiny.
  • Homocysteine exerts toxicity through oxidative stress, nitric oxide binding, protein homocysteinylation, and hypomethylation.
  • Macromolecule hypomethylation is a common feature in CRF, potentially leading to functional consequences.

Conclusions:

  • Hyperhomocysteinemia is a significant cardiovascular risk factor, particularly in CRF.
  • Understanding homocysteine's toxic pathways is crucial for managing cardiovascular risk in CRF patients.
  • Clinical trials are pending to determine the efficacy of homocysteine-lowering therapies in reducing cardiovascular events.

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