Oxidative Stress in Cystinosis Patients

Background/Aims: Nephropathic cystinosis (NC) is a severe systemic disease and cysteamine improves its prognosis. Lysosomal cystine accumulation is the hallmark of cystinosis and is regarded as the primary defect due to mutations in the CTNS gene. However, there is great evidence that cystine accumulation itself is not responsible for all abnormalities observed in NC. Studies have demonstrated altered ATP metabolism, increased apoptosis, and cell oxidation. An increased number of autophagosomes and autophagic vacuoles have been observed in cystinotic fibroblasts and renal epithelial cells, suggesting that altered autophagy plays a role in NC, leading to increased production of reactive oxygen species. Therefore, cystinosis patients can be more susceptible to oxidative stress (OS) and it can contribute to the progression of the renal disease. Our goal was to evaluate a marker of OS (serum TBARS) in NC children, and to compare the results with those observed in healthy controls and correlated with renal function parameters. Methods: The study included patients aged under 18 years, with good adherence to the treatment and out of renal replacement therapy. The following parameters were evaluated: serum creatinine, BUN, creatinine clearance estimated by stature and serum TBARS levels. Results: We selected 20 patients aged 8.0 ±3.6 years and observed serum TBARS levels of 4.03 ±1.02 nmol/ml. Serum TBARS levels in the 43 healthy controls, aged 7.4 ±1.1 years, were 1.60 ±0.04 nmol/ml. There was a significant difference between the plasma TBARS levels among the 2 groups (p Conclusion: An increased level of serum TBARS in patients with NC was observed and this abnormality was not correlated with the renal function status degree. This is the first report that shows increased oxidative stress in serum of NC patients

Marcadores práticos de função renal em pacientes com cistinose

INTRODUÇÃO: Cistinose é uma doença sistêmica, autossômica recessiva, que leva à insuficiência renal crônica na infância, a não ser que o tratamento com cisteamina seja iniciado precocemente. Mesmo nestas condições, os pacientes evoluem para doença renal crônica terminal por volta da segunda década da vida. Portanto, a avaliação da função renal é essencial neste grupo de pacientes. OBJETIVO: Avaliar e correlacionar a cistatina C, creatinina sérica e o clearance de creatinina pela Fórmula de Schwartz em pacientes com cistinose, com diferentes graus de função renal. MÉTODOS: Foram incluídos pacientes com menos de 18 anos de idade, com diferentes níveis de função renal, de acordo com o KDOQI em estágios 1 a 4. Nenhum dos pacientes estava em terapia de substituição renal. Foram medidos os seguintes parâmetros: cistatina C, creatinina sérica e o clearance de creatinina pela fórmula de Schwartz. RESULTADOS: Foram analisadas 103 amostras de sangue de 26 pacientes. Foi detectada correlação significativa entre creatinina sérica e cistatina C (r = 0,81, p < 0,0001), cistatina C e o clearance de creatinina pela fórmula de Schwartz (r = -0,84, p < 0,0001) e creatinina sérica e clearance de creatinina (r = -0,97, p < 0,0001). CONCLUSÕES: A medida da cistatina não mostrou nenhuma vantagem sobre a creatinina sérica e o clearance de creatinina pela fórmula de Schwartz em pacientes com cistinose para avaliar o ritmo de filtração glomerular. Este é o primeiro relato sobre o valor da creatinina sérica, do clearance de creatinina pela fórmula de Schwartz e da cistatina C em pacientes com cistinose