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Titolo	Homocysteine in uraemia - a puzzling and conflicting story.
Autore	Mohamed E. Suliman, Peter Böröny, Kamyar Kalantar-Zadeh, Bengt Lindholm and Peter Stenvinkel
Referenza	Nephrol Dial Transplant (2005) 20: 16-21
Contenuto	Homocysteine (Hcy) is a non-protein sulfur-containing amino acid that consists of various forms: a protein-bound fraction (70-80%), a free oxidized form (20-30%) and a free reduced form (1%), which recently has attracted considerable interest as it may, by several mechanisms (Table 1) mediate premature atherosclerosis and cardiovascular disease (CVD). Indeed, in the general population, the results have shown that even mildly elevated plasma total homocysteine (tHcy) levels are associated with an increased cardiovascular risk [1-3]. However, not all prospective cohort studies are consistent with this finding [2] and, so far, the result of a large vitamin intervention study is not promising [4]. The normal range of tHcy is 3-15 mol/l, and many factors may influence this level [5]. Beside nutritional deficiencies of B vitamins and genetic factors (C677T mutation of methylenetetrahydrofolate reductase; MTHFR), renal failure is one of the most frequent clinical causes of hyperhomocysteinaemia. Patients with end-stage renal disease (ESRD) usually have 2-3 times higher levels of tHcy and the prevalence of hyperhomocysteinaemia in this patient group is >90% [6-8]. Although several processes may explain the close correlation between kidney function and the plasma tHcy concentration, the exact mechanism(s) by which renal failure leads to hyperhomocysteinaemia are not completely understood. However, it has been reported that the fractional extraction of Hcy across the kidney is related to renal plasma flow [9].
Data	31.01.2005

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