International Journal of Biological & Medical Research

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Int J Biol Med Res. 2010; 1(4): 144-148 Int J Biol Med Res Volume 3, Issue 4, Sep 2010 www.biomedsidiret.

om International Journal of BIOLOGICAL AND MEDICAL RESEARCH Original artile Oxidant stress in primary nephroti syndrome in relation to dyslipidemia a b Angoorbala Bafna *,Purnima Dey Sarkar.

1 Int J Biol Med Res. 2010; 1(4): Int J Biol Med Res Volume 3, Issue 4, Sep ISSN: 0976:6685 BioMedSiDiret Publiations Contents lists available at BioMedSiDiret Publiations International Journal of Biologial & Medial Researh Journal homepage: International Journal of BIOLOGICAL AND MEDICAL RESEARCH Original artile Oxidant stress in primary nephroti syndrome in relation to dyslipidemia a b Angoorbala Bafna *,Purnima Dey Sarkar. *a Post Graduate Department of Biohemistry,Govt.Holkar Siene College,Indore , Madhya Pradesh,India, b Department of Biohemistry, M.Y. Medial College, Indore , Madhya Pradesh,India A R T I C L E I N F O A B S T R A C T Keywords: Dyslipidemia Malondialdehyde Nephroti syndrome Primary Nephroti syndrome Total antioxidant Capaity Nephroti Syndrome is a onsequene of an imbalane between oxidants and antioxidants. The present study aimed to assess oxidants and antioxidants status in relation to dyslipidemia in adults Nephroti Syndrome patients and during remission. The study dealt with 75 adults diagnosed to have primary Nephroti Syndrome (PNS) and all were given standard oral ortiosteroid indution therapy and 50 normal healthy adults were kept for ontrol. Blood samples were analyzed for quantifiation of albumin, malondialdehyde (MDA) as an index of lipid per-oxidation,total holesterol(tc), Triglyerides(TG), High density lipoprotein holesterol (HDL-C), Low density lipoprotein Cholesterol(LDL-C),Total antioxidant apaity (TAC), Copper and Zin from ontrol and experimental patients. Signifiantly inreased level of MDA, TC, and TG was noted while signifiantly dereased levels of HDL-C TAC, Zin and Copper were notied in the patients with Nephroti Syndrome as ompared to healthy ontrol. However, after standard ortiosteroids indution therapy signifiant redution in MDA, TC, TG, were observed but no signifiant hange in LDL-C was observed. Although improvement in TAC, HDL-C albumin, Zin and Copper were observed after standard ortiosteroids indution therapy. Copyright 2010 BioMedSiDiret Publiations IJBMR - ISSN: 0976:6685. All rights reserved. 1. Introdution The Nephroti Syndrome is one of the best known presentations of adult or pediatri kidney disease. The term desribes the assoiation of (heavy) proteinuria with peripheral edema, Hypoalbuminemia and hyperholesterolemia. Low TAC onentrations have been reported in the proteinuri phase of SSNS during the first episode [1]. An abnormality in oxidative system in patients with Nephroti syndrome has been reported [2, 3].Dyslipidemia of NS is also known to be linked to oxidative reations and atheroslerosis [4]. Diret assessment of reative oxygen speies (ROS) is not feasible beause of the extremely short half-life of the free radials [4]. Therefore, the oxidative ativity must be measured indiretly by the levels of lipid membranes per oxidation by-produt; malondialdehyde (MDA). Also, by measuring the Total Antioxidant Capaity (TAC), albumin (whih is an antioxidant protein and its redued thiol moiety on ystein 34 plays diret role of antioxidant) [5][6], serum zin & opper * Corresponding Author : Angooorbala Bafna Assistant Professor,Department of Biohemistry Government Holkar Siene College, Indore , Madhya Pradesh,India. Tel , Mobile balaindore@yahoo.om Copyright 2010 BioMedSiDiret Publiations. All rights reserved. level[7]. The present study, aimed, was to assess oxidant (in terms of serum levels of MDA) and antioxidant status (in terms of serum levels of albumin, TAC, Zin and Copper), in relation to dyslipidemia( in terms of serum levels of TC, LDL-C, HDL-C, TG,) in adult Nephroti Syndrome patient and during remission phase of steroid sensitive Nephroti syndrome (SSNS). 2. Materials and Methods 2.1 Study population-human Present study was onduted during January 2007 to Deember 2009 on Nephroti Syndrome subjets who were outdoor patients of Nephrology Department of M.G.M. Medial College and private linial of Indore (M.P.), India. 2.2 Test-Disease: Nephroti Syndrome. The present study was onduted on 75 adult Nephroti syndrome patients. Patients were diagnosed to have primary Nephroti syndrome aording to the riteria of the International Study of Kidney Disease in Children (ISKDC) 1981.The patients suffering from other diseases whih may lead to oxidative stress suh as diabetes, inflammatory disease, ardia disease, hepati impairment and respiratory diseases or other systemi disease as well as smokers and aloholis were exluded from the study.

2 145 study. The study was approved by the ethial ommittee of the D.A.V.V.Indore. 2.3 Experimental design The present study was onduted on 50 healthy adult ontrol subjets and on 75 adults' Nephroti syndrome patients. Studied subjets were divided in the following three groups. A Control Group: In this group 50 normal healthy adults were inluded. B Experimental Group 1: In this group 75 adult Nephroti syndrome patients were inluded. C Experimental Group 2: In this group 75 adult Nephroti syndrome patients whih were on remission after reeiving standard oral ortiosteroid indution therapy for one month were inluded. 2.4 Biohemial investigation Fasting venous blood were drawn from all subjets. The blood was allowed to lot at room temperature and entrifuged at 5000 rpm for 10 minutes and then the serum was kept frozen at - 70 C in aliquots until the time of assay of the parameters. The prospetive study was arried out at Biohemistry laboratory of the Government Holkar Siene College Indore(M.P.). Biohemial parameters seleted for present study inluded. Total Cholesterol, Triglyeride, HDL-Cholesterol Albumin, Zin, and Copper were determined by using ommerially available kit from Lab Kit diagnostis from Span in semi automated auto analyzer. LDL-Cholesterol level was alulated by using Friedewald's equation. 2.5 Measurement of serum TAC Serum TAC was measured aording to the method desribed by Koraevi et al. [8] in whih the determination of Total antioxidant apaity is based on the reation of Antioxidants in the sample with a defined amount of exogenously provided Hydrogen peroxide. The antioxidants in the sample eliminate a ertain amount of the Hydrogen peroxide and the residual hydrogen peroxide is determined by an enzymati reation (the onversion of 3, 5 dihloro-2-hydroxy benzene sulphonate) produes olored produt. Measure the absorbane at 532 nm wavelength. 2.6 Measurement of serum MDA The olorimetri method desribed by Ohkawa et al. [9] was used to measure serum MDA level. The reation of Thiobarbituri aid with MDA in an aidi medium at 95 C for 30 min produes pink olored thiobarbituri aid reative produt. The absorbane of the pink olored produt was measured at 534 nm wavelength. 2.7 Statistial analysis The SPSS software programmed ver.15 (SPSS, Chiago, IL) was used to analyze the data statistially. Laboratory harateristis of patients were expressed as mean ± standard deviation (SD).ANOVA was used to ompare these data between patients and ontrols. P values <0.05 was onsidered to be signifiant. 3. Results Results obtained were summarized in Table's 1-3.Table 1 shows Comparison of all diagnosed biohemial parameter in healthy ontrol group and experimental group 1 with SSNS. Signifiantly inreased mean serum level of MDA, TC, LDL-C, TG (p<0.000) and signifiantly dereased level of HDL-C (p<0.001) in group 1 were observed when ompared to healthy ontrol. In serum level of MDA overall % inrease was observed in group 1. In serum level of Total holesterol overall % inrease was observed in group1. In serum level of triglyeride overall % inrease was observed in group 1. In serum level of LDL-C overall 100 % inrease was observed in group 1. In serum level of HDL-C overall 8.99 % derease was observed in group 1. Signifiantly dereased mean serum level of albumin, Zin, Copper, TAC, were observed in group 1 when ompared to healthy ontrol (p<0.000). In serum level of Albumin overall % derease was Observed in group 1. In serum level of Zin overall % derease was observed in group 1. In serum level of Copper overall 17.0 % derease was observed in group 1. In serum level of TAC overall % derease was observed in group 1. In serum level TAC overall 32.98% derease was observed Table 2 shows omparison of all diagnosed biohemial parameter in healthy ontrol group and experimental group 2 with SSNS. Signifiantly different mean serum level of MDA, TC, LDL-C, and TG (p<0.000) were observed in experimental group 2 and insignifiant differene was observed in serum HDL-C level of experimental group 2 when ompared to healthy ontrol. In serum level of MDA overall % differene was observed in group 2. In serum level of total holesterol overall % differene was observed in group 2. In serum level of triglyeride overall % differene was observed in group 2. In serum level of LDL-C overall % differene was observed in group 2. In Serum level of HDL-C overall 3.59 % differene was remained in group 2.Signifiantly dereased mean serum level of albumin and TAC, were observed in group 2 when ompared to healthy ontrol (p<0.000). In serum level of Albumin overall % differene was observed in group 2. In serum level of TAC overall % differene was observed in group 2. Insignifiant differene was observed in serum level of Zin and opper of experimental group 2 when ompared to healthy ontrol. In serum level of Copper overall 4.53 % differene was observed in group 2. In serum level of Zin overall 0.72 % differene was observed in group 2. ` Table 3 shows omparison of all diagnosed biohemial parameter in experimental group 2 and group 1 with SSNS. Signifiantly dereased mean serum levels of MDA, TC, and TG in group 2 were observed when ompared to group1 (p<0.000). Signifiant inreased level of HDL-C in group 2 was observed when ompared to group1 (p<0.006). In serum level of MDA overall 39.04% derease was observed in group 2. In serum level of Total holesterol overall % derease was observed in group2. In serum level of triglyeride overall % derease was observed in group 2. In serum level of LDL-C overall 6.32 % derease was observed in group 2. In serum level of HDL-C overall 5.93 % inrease was observed in group 2. No signifiant differene in serum LDL-C was observed in group 2 when ompared to group1 (p<0.077). Signifiantly inreased mean serum level of albumin, Zin, Copper, TAC, were observed in group 2 when ompared to group 1 (p<0.000). In serum level of Albumin overall % inrease was observed in group 2. In serum level of Zin overall % inrease was observed in group 2. In serum level of Copper overall % inrease was observed in group 2. In serum level of TAC overall % inrease was observed in group 2.

3 146 Tables. Results obtained were summarized in Table's 1-3. Table 1. Comparison of all diagnosed biohemial parameter in Control and group 1 with SSNS. Parameter Control Group 1 Differene % hange p-value 4.33± ± ± ± ± ± Zin (µg/dl) ± ± ± ± ± ± ± ± ± ± *** ± ± *** Extremely signifiant, ** highly signifiant, Table 2. Comparison of all diagnosed biohemial parameter in Control and group 2 with SSNS. Parameter Control Group 2 Differene % hange p-value 4.33± ± ± ± ± ± Zin (µg/dl) ± ± NS ± ± NS ± ± ± ± ± ± NS ± ± *** Extremely signifiant, ** highly signifiant, NS- Insignifiant Table 3. Comparison of all diagnosed biohemial parameter in group 1 and group 2 with SSNS. Parameter Group 1 Group 2 Differene % hange p-value 2.47± ± ± ± ± ± Zin (µg/dl) 92.75± ± ± ± ± ± ± ± ± ± *** ± ± NS *** Extremely signifiant, ** highly signifiant, NS- Insignifiant

4 Disussion Dyslipidemia is a ontributory fator in the progression of initial glomerular injury in NS [10].In the present study signifiantly inreased mean serum level of TC, LDL-C, TG and signifiantly dereased level of HDL-C in group 1 was observed when ompared to healthy ontrol, although dyslipidemia is a ommon ompliation of NS. The inreased level of serum TC ould be attributed to impaired metabolism of mevalonate by the nephroti kidney. This allows a greater holesterol availability that oupled with an enhaned Hydroxy Methyl Glutaryl-CoA (HMG-CoA) redutase ativity leads to inreased hepati holesterol synthesis and unbalaned lipid homeostasis [10]. HDL-C is an effetive antioxidant with the apaity to inhibit oxidative modifiation of LDL-C.HDL-C also possesses antiinflammatory properties. These antioxidant and antiinflammatory properties of HDL-C may be as important as its holesterol efflux funtion in terms of proteting against development of atheroslerosis [11]. In our study we also found that serum MDA level was inreased in group 1 as ompared to healthy ontrol and serum TAC, Copper and Zin was signifiantly dereased in group1 as ompared to healthy ontrol. These findings are orroborating with the finding of previous studies [12, 13, and 10]. Elevated plasma MDA level in nephroti syndrome is strongly assoiated with the severity of nephroti syndrome and renal injury. [14] Zin defiieny was probably a onsequene of redued absorption of Zin in onjugation with exessive urinary loss [15]. Nephroti Syndrome patients may be assoiated with exretion of Ceruloplasmin a protein, whih is normally not found in urine. Urinary opper loss is in diret proportion to the amount of Proteinuria [16]. Both eruloplasmin and opper levels derease in nephroti syndrome patients [17]. Hypoupremia assoiated to Nephroti syndrome is seondary to renal loss of opper proteins. Per-oxidation of lipid membrane raises the onentration of the MDA that results in lowering of the onentration of antioxidants beause of onsumption (4). Albumin is a leading preventive but not a hain breaking antioxidant of serum. In the present study, signifiantly lower level of mean serum albumin was observed in group 1 in omparison with those of the healthy ontrol. It is reported that even at very low onentration, albumin has a high antioxidant ativity [12]. Mean serum levels of TAC signifiantly dereased in SSNS adults. These dereased levels suggest depletion, possibly beause of onsumption for neutralizing exessive irulating oxidants [13]. In Present study we observed normalization of serum Zin, Copper and HDL-C level in group 2 after the use of ortiosteroid indution therapy. There was no normalization in serum level of TC, TG, LDL-C, MDA, and TAC in group 2 however, despite the use of ortiosteroids. These findings are in agreement with previous study [18]. From our study and onsidering the results of some other experimental studies it is believed that steroids diretly or indiretly impair the antioxidant reations and lead to over prodution of reative oxygen speies (ROS).The use of antioxidant therapy in NS opens a promising field in prevention of oxidative stress related pathologies in renal patients. Vitamin C, and E and also ombination magnesium, Zin, Vitamin C and E supplements was effetive in improvement of glomerular but not tubular renal funtion in type 2 diabetes patients [19].The benefiial effets of antioxidants, minerals and B-omplex vitamins on oxidative stress in Nephroti Syndrome patients was also reported by dwivedi et al. (7). 5. Conlusion The findings of the present study display an inreased oxidative stress and dereased antioxidant response in SSNS adults. Additionally, although there is linial remission no normalization of the biohemial indies was observed despite the use of ortiosteroids. Therefore, there might be a potential role for regular lipid monitoring during the follow-up of Nephroti patients to identify high-risk patients, who should be evaluated as andidates for a lipid lowering therapy. Therefore, the present s t u dy re o m m e n d s t h e o m b i n e d u s e o f s t e ro i d, antioxidanttherapy, and lipid lowering therapy in suh adults to prevent development of NS related ompliations with more frequently and long term follow up in large number of patients would be neessary. Aknowledgements We sinerely thankful to Dr S.L.Garg,Prinipal, and Prof R.S.Maheshwari, HOD Biohemistry, Govt. Holkar Siene College Indore (M.P.)for providing neessary laboratory failities and enouragement. 6.Referenes [1] Zahwieja J, Bobkowski W, Dobrowolska-zahwieja ZaniewM, Maiejewski J. Dereased antioxidant ativity in hyperholesterolemi hildren with nephroti syndrome. Med Si Monit.2003; 9: [2] Buluu F, Vural A, Aydin A, Sayal A.Oxidative stress status inadults with nephriti syndrome. Clin Nephrol.2000;53: [3] Kinra S, Rath B, Kabi BC. indiret quantifiation of lipid peroxidation in steroid responsive nephroti syndrome. Arh Dis. Child.2000; 82: [4] Ee A, Atamer Y, Gurkan F, Bilii M, Koyigit Y. Anti-oxidant status in relation to Lipoproteins, leptin and pro-inflammatory ytokines in hildren with steroid-sensitive nephriti syndrome. Nephrology.2004; 9: [5] Verrotti A, Basiani F, Trotta D, Pomilio MP, Morgese G, Chiarelli F.Serum opper, zin, selenium, glutathione peroxidase and superoxide dismutase levels in epilepti hildren before and after 1 y of sodium valproate and arbamazepine therapy. Epilepsy Res. 2002; 48: [6] Quinlan GJ, Mumby S, Martin GS, Bernard GR, Gutteridge JM, Evans TW. Albumin influenes total plasma antioxidant apaity favorably in patients with aute lung injury. Crit Care Med. 2004; 32: [7] D w i v e d i J, S a r k a r P D. S t u d y o f o x i d a t i v e s t r e s s, Homoysteine,Copper& Zin in nephroti syndrome :therapy with antioxidants minerals and B-omplex Vitamins. J Biohem Teh1.2009;(4): [8] Koraevi D, Koraevi G, Diordjevi V, Andrejevi S, Cosi V. Method for the measurement of antioxidant ativity in human fluids.j Clin. Pathol. 2001; 54: [9] Ohkawa H, Ohishi N, Yagi K. Assay for lipid peroxides in animal tissues by thiobarbituri aid reation. Anal Biohem.1979; 95: [10] Delvin EE, Merouani A, Levy E. Dyslipidemia in pediatri nephroti syndrome: auses revisited. Clin Biohem. 2003; 36: [11] Barter PJ, Niholls S, Rye KA, Anantharamaiah GM, Navab M, Fogelman AM. Anti-inflammatory properties of HDL. Cir Res. 2004; 95: [12] Ee A, Atamer Y, Gurkan F, Davutoglu M, Koyigit Y, Tutan M.Paraoxonase, total antioxidant response and peroxide levels in hildren with steroidsensitive nephroti syndrome. Pediatr Nephrol. 2005; 20: [13] Mathew JL, Kabi BC, Rath B. Anti-oxidant vitamins and steroid responsive nephroti syndrome in Indian hildren. J Paediatr Child Health. 2002; 38: [14] Alifl M, Buluu1F, Baykal Y, Yamanel L, Inal V, Serdar M, Avi A, Aydin A. Oxidative Stress Status in Renal Tissue and Plasma of Experimental Nephroti Syndrome.The Turkish Soiety of Nephrology. 2008; 17 (2)

5 148 A Bafna and PD Sarkar / Int J Biol Med Res. 2010; 1(4): [15] Stek J, Podraka L,pavkovekova O,Kollar J.Zin and opper metabolism in nephroti syndrome.nephron.1990;56: [16] Nai MSS, Murat M, Koglu C, Eran A. Zin and opper defiienyin maintenane Hemodialysis patients with end stage renal disease. Nephrology.1991; 4 (1) [17] Herbert E. Spiegel advane in linial biohemistry. V 37: Published by aademi press.2003; Page 203 ISNB , [18] El-Melegy NT, Mohamed NA, Sayed MM. Oxidative modifiation of low density Lipoprotein in relation to Dyslipidemia and oxidant status in hildren with Steroid Sensitive Nephroti Syndrome. Pediatr. Res.2008; 63(4): [19] Maryam SF, Mahmoud J, Ferrydoun S, Mostafa H. Comparision of the effets of vitamins and mineral supplementations on glomerular and tubular dysfuntion in type2 diabeti's. Diabetes are.2005; 28(10): Copyright 2010 BioMedSiDiret Publiations IJBMR - ISSN: 0976:6685. All rights reserved.

International Journal of Biological & Medical Research

International Journal of Biological & Medical Research Int J Biol Med Res. 2013; 4(3) :3414-3418 Int J Biol Med Res Volume 3, Issue 1, Jan 2012 www.biomedsidiret.om BioMedSiDiret Publiations Contents lists available at BioMedSiDiret Publiations International