Evaluation of Kidney Function Parameters in Children with Vitamin B12 Deficiency

Öz

Objective: Vitamin B12 is crucial for cell metabolism, deoxyribonucleic acid synthesis and cell proliferation. Hematological and neurological systems are known to be affected in vitamin B12 deficiency. The aim of this study was to research the effects of vitamin B12 deficiency on kidney function parameters.

Material and Methods: Thirty-four children with vitamin B12 deficiency and 36 sex and age-matched healthy controls were included in the study. Complete blood count, serum urea, creatinin, vitamin B12, holotranscobalamin, methyl malonic acid, homocysteine, ferritin, folate and estimated glomerular filtration rate were recorded. Additionally, spot urine protein, microalbumin and neutrophil gelatinase-associated lipocalin were measured.

Results: Kidney function parameters were normal for childrens that participated the study. Serum kidney function parameters adjusted for age also showed no significant difference between the two groups. No correlation was found between serum vitamin B12 and neutrophil gelatinase-associated lipocalin; however, a negative correlation was detected between neutrophil gelatinase-associated lipocalin and holotranscobalamin (r =-0.24, p =0.045). Holotranscobalamin was substantially lower in the group with vitamin B12 deficiency (p<0.001).

Conclusion: No negative influence of B12 deficiency on kidney function was found in non-anemic children.

Anahtar Kelimeler

• Child
• Holotranscobalamin
• Kidney function
• Vitamin B12 deficiency

Vitamin B12 Eksikliği Olan Çocuk Hastalarda Böbrek Fonksiyon Parametrelerinin Değerlendirilmesi

Öz

Amaç: Vitamin B12, hücre metabolizması, deoksiribo nükleik asit sentezi, hücre proliferasyonu için yaşamsal öneme sahiptir. Vitamin B12 eksikliğinde nörolojik ve hematolojik sistemin etkilendiği bilinmektedir. Bu çalışmada da, vitamin B12 eksikliğinin böbrek fonksiyonları üzerine etkisinin incelenmesi amaçlandı.

Gereç ve Yöntemler: Vitamin B12 eksikliği olan 34, yaş ve cinsiyet özellikleri açısından benzer özellikler gösteren 36 sağlıklı çocuk çalışmaya dahil edildi. Hastalara ait tam kan sayımı, serum üre, kreatinin, vitamin B12, holotranskobalamin, metil malonik asit, homosistein, ferritin, folat düzeyleri ve tahmini glomerüler filtrasyon hızı kaydedildi. Ayrıca, idrarda protein, mikroalbumin ve nötrofil jelatinaz ilişkili lipokalin değerleri ölçüldü.

Bulgular: Çalışmaya katılan çocukların böbrek fonksiyonlarını gösteren parametreler normal değerlerdeydi. Böbrek fonksiyonları ile ilgili parametreler açısından vitamin B12 eksikliği olan ve olmayan hastalar arasında anlamlı fark yoktu. Her iki grup arasında vitamin B12 ve nötrofil jelatinaz ilişkili lipokalin arasında korelasyon bulunmadı, ama holotranskobalamin ve nötrofil jelatinaz ilişkili lipokalin arasında negatif korelasyon saptandı (r =-0.24, p =0.045). Holotranskobalamin vitamin B12 eksikliği olan grupta anlamlı derecede düşüktü (p<0.001).

Sonuç: Anemisi olmayan çocuklarda vitamin B12 eksikliğinin böbrek fonksiyonları üzerine belirgin olumsuz etkisi bulunamamıştır.

Anahtar Kelimeler

• children
• vitamin B12 deficiency
• uNGAL
• kidney function
• holotranscobalamin

Kaynakça

1. Referans1. Stabler SP and Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr 2004;24: 299-326.
2. Referans2. Allen LH, Rosado JL, Casterline JE, López P, Muñoz E, García OP, et al. Lack of hemoglobin response to iron supplementation in anemic Mexican preschoolers with multiple micronutrient deficiencies. The American journal of clinical nutrition 2000; 71(6):1485-1494.
3. Referans3. Buchanan AO, Marquez ML. Pediatric nutrition and nutriotional disorders. In: Marcdante KJ, Kliegman RM, editors. Nelson Essential of Pediatrics. 8 th ed. New York: Elsevier; 2019. p. 287-311.
4. Referans4. Valente E, Scott JM, Ueland PM, Cunningham C, Casey M and Molloy AM. Diagnostic accuracy of holotranscobalamin, methylmalonic acid, serum cobalamin, and other indicators of tissue vitamin B12 status in the elderly. Clinical chemistry 2011;57(6):856-63.
5. Referans5. Zwiers AJ, de Wildt SN, van Rosmalen J, de Rijke YB, Buijs EA, Tibboel D, et al. Urinary neutrophil gelatinase-associated lipocalin identifies critically ill young children with acute kidney injury following intensive care admission: a prospective cohort study. Critical Care 2015;19(1): 1-14.
6. Referans6. Güneş A, Aktar F, Tan İ, Söker M, Uluca Ü, Balık H, et al. Urinary levels of early kidney injury molecules in children with vitamin B12 deficiency. Archivos argentinos de pediatria 2016;114(5): 453-457.
7. Referans7. McMahon GM, Hwang SJ, Tanner RM, Jacques PF, Selhub J, Muntner P, et al. The association between vitamin B12, albuminuria and reduced kidney function: an observational cohort study. BMC nephrology 2015; 16(1): 1-8.
8. Referans8. Miliku K, Mesu A, Franco OH, Hofman A, Steegers EA and Jaddoe VW. Maternal and fetal folate, vitamin B12, and homocysteine concentrations and childhood kidney outcomes. Am J Kidney Dis 2017;69(4): 521-30.

9. Referans9. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity 2011.(No. WHO/NMH/NHD/MNM/11.1)
10. Referans10. Carmel R. Biomarkers of cobalamin (vitamin B-12) status in the epidemiologic setting: a critical overview of context, applications, and performance characteristics of cobalamin, methylmalonic acid and holotranscobalamin II. Am J Clin Nutr 2011; 94(1): 348-58.
11. Referans11. Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 2009;4(11):1832-43.
12. Referans12. Yetim A, Tıkız C and Baş F. Prevelance of vitamin D and B12 deficiency in adolescence. The Journal of the Child 2017; 17(1): 24-9.
13. Referans13. Kumagai H, Katoh S, Hirosawa K, Kimura M, Hishida A and Ikegaya N. Renal tubulointerstitial injury in weanling rats with hyperhomocysteinemia. Kidney Int 2002;62(4): 1219-28.
14. Referans14. Zappitelli M, Washburn KK, Arikan AA, et al. Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Critical Care 2007;11(4): 84.
15. Referans15. Bor MV, Nexø E and Hvas AM. Holo-transcobalamin concentration and transcobalamin saturation reflect recent vitamin B12 absorption better than does serum vitamin B12. Clin Chem 2004; 50(6):1043-9.
16. Referans16. Nexo E and Hoffmann-Lücke E. Holotranscobalamin, a marker of vitamin B-12 status: analytical aspects and clinical utility. Am J Clin Nutr 2011; 94(1): 359-65.
17. Referans17. Bamonti F, Moscato GA, Novembrino C, Gregori D, Novi C, De Giuseppe R, et al. Determination of serum holotranscobalamin concentrations with the AxSYM active B12 assay: cut-off point evaluation in the clinical laboratory. Clinical Chemistry and Laboratory Medicine 2010;48(2): 249-253.