ascorbic-acid and Nephrotic-Syndrome

It is well documented that oxidative stress is involved in the pathogenesis of idiopathic nephrotic syndrome (INS). Malondialdehyde (MDA) is a measurement of lipid oxidation; vitamin C and E are important components of antioxidants. However, the association between MDA, vitamin C or E levels and INS remains elusive. A meta-analysis was performed to investigate the alteration of serum levels of MDA, vitamin C and E in INS compared with controls. Eight studies were included in our meta-analysis according to predefined criteria. Active INS patients demonstrated significantly higher level of serum MDA (SMD: 2.13, 95% CI: 1.511 to 2.749, p < 10(-4)), markedly lower levels of serum vitamin C (SMD: -1.449, 95% CI: -2.616 to -0.281, p = 0.015) and E (SMD: -1.45, 95% CI: -2.544 to -0.356, p = 0.009) compared with those in controls. Active steroid-sensitive nephrotic syndrome (SSNS) patients showed comparable levels of serum vitamin C and E to those in controls. INS subjects in the remission stage demonstrated significantly higher level of serum MDA (SMD: 1.028, 95% CI: 0.438 to 1.617, p < 10(-4)), markedly lower level of serum vitamin C (SMD: -2.235, 95% CI: -3.048 to -1.421, p < 10(4)) and similar level of serum vitamin E compared with those in controls. No significant publication bias was observed. In conclusion, the disorder of MDA and vitamin C persists in the remission stage of INS. It seems that the serum levels of vitamin C and E is associated with the responsiveness of INS to steroids. However, more studies should be performed in the future.

Topics: Ascorbic Acid; Humans; Malondialdehyde; Nephrotic Syndrome; Vitamin E

Eighteen children with steroid-sensitive nephrotic syndrome (SSNS) were studied. The control group comprised 20 healthy children. The following indirect parameters of reactive oxygen species activity were determined in nephrotic patients during four stages of the disease (full relapse before prednisone administration, disappearance of proteinuria, prednisone cessation, unmaintained remission): plasma malondialdehyde (MDA) levels, copper/zinc superoxide dismutase (CuZn SOD) activity and glutathione peroxidase (GPX) activity in erythrocytes, reduced glutathione (GSH) and vitamin C levels in whole blood, and vitamin E level in serum. Increased MDA levels, reduced vitamin C levels, and enhanced CuZn SOD activity were found in relapse. GSH concentration was high during all four stages. Vitamin E level was also increased, parallel to the pattern of serum lipids. GPX activity remained low during the proteinuria stage and in remission. We conclude that the majority of abnormal findings can be attributed to the hyperlipidemia of NS. Low GPX activity may be a factor limiting the antioxidant capacity in NS. The present study is inconclusive regarding the role of free radicals in the proteinuria of NS.

Topics: Adolescent; Anti-Inflammatory Agents; Antioxidants; Ascorbic Acid; Child; Child, Preschool; Cholesterol, HDL; Cholesterol, LDL; Glutathione; Glutathione Peroxidase; Humans; Nephrotic Syndrome; Prednisone; Proteinuria; Reactive Oxygen Species; Superoxide Dismutase; Triglycerides

The production of free radicals can cause renal injury and play an important role in the pathogenesis of idiopathic nephrotic syndrome. Markers of reactive oxygen species (ROS) were evaluated in 48 patients with active nephrotic syndrome (ANS) and 30 age- and gender-matched healthy children. Plasma malondialdehyde (MDA), protein carbonyl, nitrite, copper, zinc, selenium, ascorbic acid, and superoxide dismutase (SOD) levels were estimated in patients with ANS and controls. Measurements were repeated in 39 cases after achievement of remission, and in 10 other children who were in remission of >6 months' duration. Plasma MDA and nitrite levels were significantly higher and selenium was lower in ANS patients compared with controls. Plasma protein carbonyl, copper ascorbic acid, zinc, and superoxide dismutase levels were comparable in ANS patients and controls. Plasma copper level was significantly higher in active cases than in the remission and long-term remission groups. Selenium value showed a rise and then normalized in long-term remission. Among different sub-groups of ANS, no significant differences were found in the levels of various parameters, except plasma selenium, which was significantly lower in first-attack nephrotic syndrome (FANS) in comparison to infrequently relapsing nephrotic syndrome (IRNS) and frequently relapsing nephrotic syndrome (FRNS) patients. Thus, we observed evidence of oxidative stress and impaired antioxidant defense during acute nephrotic syndrome. Antioxidant status recovered completely only during long-term remission.

Topics: Analysis of Variance; Antioxidants; Ascorbic Acid; Case-Control Studies; Child; Child, Preschool; Copper; Disease-Free Survival; Female; Humans; Infant; Male; Malondialdehyde; Nephrotic Syndrome; Nitrites; Oxidative Stress; Protein Carbonylation; Reactive Oxygen Species; Recurrence; Selenium; Statistics, Nonparametric; Superoxide Dismutase; Zinc

Disorders of lipid metabolism and antioxidant defense capacity reported during idiopathic nephrotic syndrome (INS) exacerbations are known. The aim of this study was to evaluate constituents of antioxidant defense [total antioxidant potential: ferric-reducing antioxidant power (FRAP), paraoxonase-1 (PON-1), tocopherols, ascorbic acid] in patients formerly treated for INS. The studied group consisted of 30 patients (20 males and 10 females) treated 4-15 years ago for INS. The control group consisted of 30 healthy teenagers. There were no statistically significant differences in PON-1 activity (156.4 +/- 97.1 vs 137.7 +/- 80.2 U/l), alpha-tocopherol levels (23.9 +/- 7.3 vs 22.4 +/- 3.2 micromol/l) and sum of beta- and gamma-tocopherols (2.1 +/- 1.0 vs 2.3 +/- 0.6 micromol/l), and in FRAP (484.9 +/- 87.2 vs 452.8 +/- 76.9 micromol/l) between groups. In the study group, a significantly lower concentration of ascorbic acid (53.0 +/- 20.8 vs 69.4 +/- 16 micromol/l; p < 0.002), decreased values of alpha-tocopherol/cholesterol (4.9 +/- 0.7 vs 5.5 +/- 1.2; p = 0.03), and total tocopherol/cholesterol (5.3 +/- 0.8 vs 6.1 +/- 1.4; p = 0.016) ratios were observed. A positive correlation between tocopherol/total cholesterol (TCh) (r = 0.41; p < 0.05) and alpha-tocopherol/TCh (r = 0.50; p < 0.001) ratios and INS relapse frequency was reported. The relationship between the study parameters and group of variables (relapse frequency, duration of the last remission, age, gender) was tested using the multiple linear regression analysis. The results of this study suggest that the nonenzymatic antioxidant defense in young persons formerly treated for INS is weaker than in their healthy counterparts.

Topics: Adolescent; Anthropometry; Antioxidants; Aryldialkylphosphatase; Ascorbic Acid; Case-Control Studies; Chlorambucil; Cholesterol; Cyclophosphamide; Dose-Response Relationship, Drug; Female; Ferric Compounds; Glomerular Filtration Rate; Glucocorticoids; Humans; Immunosuppressive Agents; Interviews as Topic; Kidney Function Tests; Male; Nephrotic Syndrome; Physical Examination; Prednisolone; Recurrence; Remission Induction; Sex Factors; Tocopherols

Malondialdehyde (MDA), ascorbic acid and reduced glutathione (GSH) have been reported to play a possible role in glycation of proteins. This study was performed to evaluate this correlation in nephrotic syndrome patients by comparing the levels of fructosamine with MDA, ascorbic acid and GSH.. Fifteen children with nephrotic syndrome during relapse and 10 age- and sex-matched healthy controls were enrolled for this study. Whole blood GSH, plasma MDA, total ascorbic acid and fasting glucose were analyzed in both the groups. Partial correlation analysis was performed to predict the independent association of MDA, ascorbic acid and GSH on fructosamine.. Plasma MDA and fructosamine levels were found to be increased in nephrotic syndrome patients when compared with controls. Plasma ascorbic acid and whole blood GSH were decreased in nephrotic group vs. healthy controls. Partial correlation analysis showed a significant positive correlation between fructosamine and MDA.. Present data point to a possible involvement of MDA in the glycation of protein in non-diabetic nephrotic syndrome patients, and provide support for the potential use of an antioxidant therapy in these patients.

Topics: Ascorbic Acid; Blood Glucose; Child; Child, Preschool; Cholesterol; Fructosamine; Glucose; Glutathione; Glycosylation; Humans; Linear Models; Lipid Peroxidation; Malondialdehyde; Nephrotic Syndrome; Serum Albumin; Triglycerides

Hemodynamic maladjustment with predominant constriction at the efferent arteriole has been encountered in a variety of clinical settings of glomerulonephropathy. In essence, it induces not only intraglomerular hypertension but also exaggeratedly reduces the peritubular capillary flow, which supplies the tubulointerstitial compartment. The hemodynamic maladjustment is believed to reflect a glomerular endothelial cell dysfunction. In this regard, oxidative stress and antioxidant defect are likely responsible for the glomerular endothelial dysfunction. Improvement in renal function was accomplished following the correction of oxidant and antioxidant imbalance with antioxidant therapy and vasodilators. Following such therapy, there was a correction in hemodynamic maladjustment with a decline in intraglomerular hydrostatic pressure and an increase in renal perfusion with a subsequent increase in renal functions namely creatinine clearance, glomerular filtration rate and a decline in FEMg.

Topics: Ascorbic Acid; Glutathione; Glutathione Peroxidase; Hemodynamics; Humans; Kidney Failure, Chronic; Lipid Peroxidation; Nephrotic Syndrome; Oxidative Stress; Vitamin E

The increased risk of atherosclerosis in nephrotic syndrome is attributable in part to the associated hyperlipidaemia. The importance of oxidation of LDL in the atherogenic process has been recognized over the last 15 years. However, there are few data on the balance of antioxidant defences and lipoprotein oxidation in nephrotic syndrome. Plasma antioxidant vitamin concentrations and indices of LDL oxidation (LDL lipid hydroperoxide content and the susceptibility of LDL to oxidation) were measured in two groups of patients; group I comprised 29 nephrotic patients and group II comprised 25 patients with haematuria. Plasma ascorbate concentration was significantly lower in group I (the nephrotic group) compared with group II (median 13.3 versus 22.2 micromol/L; P<0.001). Vitamin E concentrations were higher in group I but were not significantly different if corrected for total plasma cholesterol (6.12 versus 5.88 micromol/mmol; P=0.33). However, these changes resulted in a low ascorbate:vitamin E ratio in group I (0.19 versus 0.87; P<0.0001). Despite these changes in important antioxidant vitamin concentrations, we were unable to demonstrate any increased susceptibility to LDL oxidation in vitro or any difference in LDL lipid hydroperoxide content. These data suggest that there may be a relative defect of oxidant/antioxidant balance in nephrotic syndrome which could predispose to increased oxidative stress. However, measures of LDL oxidation were not significantly different between the two groups. LDL was protected from oxidation despite the severe hyperlipidaemia and the low circulating vitamin C concentrations.

Topics: Adult; Aged; Antioxidants; Ascorbic Acid; Cholesterol; Female; Hematuria; Humans; Lipoproteins, LDL; Male; Middle Aged; Nephrotic Syndrome; Oxidative Stress; Oxygen; Vitamin E; Vitamins

In continuation of our work on human stress situation and present day awareness of the role of free radical toxicity in a variety of clinical conditions, oxidative stress status (in terms of serum levels of MDA, scavenging enzyme SOD, vitamins: C and E) has been studied in 45 pediatric patients with nephrotic syndrome (further classified as steroid: responders, frequent/ infrequent relapsers, dependents). The results have been compared with 42 appropriately age healthy children as controls. The salient features of the present study centre around typical observations viz significantly increased levels of MDA (7.92 +/- 2.24 nmol/ml), decreased levels of SOD (1.36 +/- 1.01 U/ml), vitamin C (0.49 +/- 0.17 mg/dl) and vitamin E (0.52 +/- 0.19 mg/dl) in children with nephrotic syndrome as a whole when compared with healthy controls [MDA (4.40 +/- 1.31 nmol/ml), SOD (3.04 +/- 1.83 U/ml), vitamin C (0.60 +/- 0.26 mg/dl) and vitamin E (0.68 +/- 0.25 mg/dl) respectively]. An almost similar trend was encountered in different groups as classified. However, maximum fluctuations were observed in steroid dependents. The present observations appear to be suggestive of alternative guidelines to clinicians in the absence of conventional renal biopsy as the procedure. It is felt that children with nephrotic syndrome should regularly take vitamins C and E from the health point of view.

Topics: Ascorbic Acid; Child; Child, Preschool; Female; Humans; Male; Malondialdehyde; Nephrotic Syndrome; Oxidative Stress; Superoxide Dismutase; Vitamin E

Nephrotoxicity of daunorubicin in rats and effect of tocopherol and ascorbic acid on lesions induced in kidneys by daunorubicin were examined. Daunorubicin induced nephrotic syndrome with proteinuria and hypoproteinemia. Histological changes in the glomeruli appeared as a dilatation of capillary loops and enlargement of the urinary space. The glomerular basement membrane showed minimal thickening. In tubuli protein casts were noticed. No beneficial influence of tocopherol and ascorbic acid on daunorubicin related nephrotoxicity was observed.

Topics: Animals; Ascorbic Acid; Daunorubicin; Hypoproteinemia; Kidney; Kidney Glomerulus; Male; Nephrotic Syndrome; Proteinuria; Rats; Rats, Wistar; Vitamin E

Topics: Adolescent; Ascorbic Acid; Child; Child, Preschool; Combined Modality Therapy; Drug Combinations; Drug Evaluation; Fatty Acids, Unsaturated; Glomerulonephritis; Humans; Lipids; Nephrotic Syndrome; Niacin

Topics: Ascorbic Acid; Female; Humans; Infant; Kidney Failure, Chronic; Nephrotic Syndrome

Topics: Ampicillin; Ascorbic Acid; Child; Child, Preschool; Female; Humans; Male; Methenamine; Nephrosis; Nephrotic Syndrome; Penicillin Resistance; Penicillins; Prednisone; Triamcinolone; Urinary Tract Infections