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Summary 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 re sults 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, lipo protein (a), CRP, fibrinogen, oxidative LDL were determined using appropriate methods. The incidence of macro vascular 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, disp< 0.05) as well as fibrinogen levels (4.3±1.3 vs. 3.7±0.8 g/L, p<0.05). The in cidence 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. Kratak sadržaj Uvod: Dijabetesna nefropatija jedan je od vodećih uzroka terminalne bubrežne insuficijencije. Cilj ove studije bio je ispitivanje odnosa homocisteinemije i biomarkera bu bre`ne funkcije, inflamacije i oksidativnog stresa, kao i u~e stalosti makrovaskularnih komplikacija kod bolesnika sa dijabetesnom nefropatijom. Metode: U studiju je uklju~eno 64 ispitanika sa dijabetesnom nefropatijom koji su podeljeni u dve grupe u odnosu na homocisteinemiju: hi per homociste i nemi~ni (HHcy, n=47) i normohomo cistei ne mi~ni (NHcy, n=17). Odgovaraju}im metodama su pored nivoa homocisteina u krvi odre|ivani i nivoi cistatina C, kreatinina, uree, albuminurije, klirensa kreatinina, parametara lipidskog statusa, apolipoproteina A i B, lipoproteina(a), CRP, fibrinogena, oksidisanog LDL, kao i u~estalost makrovaskularnih komplikacija dijabetesne bo - lesti. Rezultati: Dobijeni rezultati upore|ivani su sa rezultatima kontrolne grupe ispitanika (n=20) sa urednom bubre`nom funkcijom, bez prisutne dijabetesne bolesti. Rezultati ukazuju da je stepen bubre`ne disfunkcije ve}i kod HHcy nego kod NHcy pacijenata (p<0,05). Tako|e, kod HHcy pacijenata nivo oxLDL je zna~ajno vi{i u odnosu na NHcy pacijente (119,3±140,4 vs. 71,4±50,8 ng/mL, p<0,05), kao i nivofibrinogena (4,3±1,3 vs. 3,7±0,8 g/L, p<0,05). Pojava makrovaskularnih komplikacija je u~estalija kod HHcy nego NHcy pacijenata (55,3% vs. 35,3%, p> 0,05), kao i kod pacijenata sa makroalbuminurijom u od nosu na pacijente sa mikroalbuminurijom (65% vs. 39%, p<0,05). Zakljućak: Na osnovu dobijenih rezultata mo`e se zaklju~iti da je HHcy u zna~ajnom stepenu prisutna kod bolesnika sa dijabetesnom nefropatijom, naro~ito ukoliko postoji izra `enija redukcija funk cio nalne rezerve bubrega. Osim toga, u odnosu na NHcy bo lesnike, kod HHcy bolesnika sa dijabetesnom nefropatijom zna~ajno su vi{e koncentracije inflamatornih (fibrinogena) i markera oksidativnog stresa u krvi (oxLDL). Stoga je kod bolesnika sa dijabetesnom nefropatijom po`eljno redovno pra}enje homocisteina u krvi, ali i inflamatornih markera, kao i markera oksidativnog stresa.

journal of medical biochemistry

Determining the Relationship Between Homocysteinemia and Biomarkers of Inflammation, Oxidative Stress and Functional Kidney Status in Patients with Diabetic Nephropathy