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Year : 2012  |  Volume : 2  |  Issue : 2  |  Page : 57-63

Platelet aggregation in children with end-stage kidney disease in relation to level of L-arginine as a risk factor for vascular thrombosis

1 Faculty of Medicine, Zagazig University, Sharkeya, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkeya, Egypt
3 Department of Biochemistry, Faculty of Medicine, Zagazig University, Sharkeya, Egypt

Correspondence Address:
Doaa Youssef
Department of Pediatrics, Zagazig University, Sharkeya
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2249-4855.118660

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Background: L-arginine is the precursor for nitric oxide (NO) synthesis in vascular cells. The sources of L-arginine are endogenous and exogenous. Although macrophages and endothelial cells can generate L-arginine, most synthesis takes place in the liver and kidney. Level of L-arginine as of other amino acids is affected in malnourished patients; NO regulates platelet activation by inhibiting adhesion and aggregation. Objectives: The aim of the study is to evaluate the level of L-arginine in patients of end-stage kidney disease (ESKD) under regular hemodialysis and to determine its relation to platelet aggregation as a risk factor for vascular thrombosis which is a very important complication that affects the life span of those patients. In addition, we also tried to establish the relationship between L-arginine, platelet aggregation, and nutritional state of patients with ESKD. Subjects and Methods: Our study was "a case-control study", comparing data between 30 patients with ESKD under treatment with regular hemodialysis-group (A); group A1 (16)-patients with ESKD on regular hemodialysis with malnutrition, group A2 (14)-patients with ESKD on regular hemodialysis with normal nutrition state, and group B 10 subjects as healthy control group, each patient was evaluated for serum arginine level by high-performance liquid chromatography, and platelet aggregation, as well as other routine investigations. A thorough clinical history and examination were performed for all the patients. Results: Our study shows significant higher level of platelet aggregation to ADP in group A than group B (119±11.9% and 81.1±6.5% respectively, P < 0.05), a lower level of serum arginine in group A (71±45.3 μg/L) than in group B (120.5±14.6 μg/L) with P< 0.05. Also our study shows a lower level of serum arginine in group A1 (60.5±12.3 μg/L) than group A2 (83±27 μg/L) and a lower level in group A2 than group B (120.5±14.6 μg//l), and we found a negative correlation between serum arginine level and platelet aggregation expressing a more risk for thrombosis in patients with ESKD specially those with malnutrition. Conclusions: We concluded that patients with ESKD has a low level of L-arginine specially in those with malnutrition and this leads to increase in platelet aggregation and may increase the possibility of thrombus formation in malnourished patients with ESKD. We suggest the use of nutritional supplementation of L-arginine to suppress this process of atherothrombosis.

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