Serum amino acid abnormalities in pediatric patients with chronic renal failure with and without history of thromboembolic manifestations

Background: Plasma amino acid concentrations have been reported to be abnormal in patients with chronic renal failure. L-Arginine has been used to improve endothelial function by increasing nitric oxide (NO) bioavailability. The present study aim at investigating the status of plasma amino acids in pediatric patients with chronic renal failure (CRF) on regular hemodialysis (HD) with and without history of thromboembolic manifestations. Methods: The study included 21 hemodialysis patients subdivided into two groups (those with no history of thromboembolic manifestations and those with positive history of thromboembolic manifestations) The control group included 13 age and sex matched apparently healthy subjects, After careful history taking, clinical examination, the following laboratory investigations were performed: serum calcium, phosphate, albumin, and creatinine (for controls only), complete blood count (CBC) and serum amino acid analysis. Results: HD patients had a significantly lower concentration of threonine, valine, methionine, leucine, tyrosine, phenylalanine and tryptophane than the control group (p= 0.032, 0.020, 0.046, 0.011, 0.000, 0.022, and 0.004 respectively). There was no significant difference between HD patients and the control group as regard aspartic acid, serine, asparagine, glutamic acid, proline, glycine, alanine, cystine, isoleucine, lysine, histidine, and arginine. The mean serum L-arginine level was lower in 61.9% of HD patients than the mean of the controls with no significant difference. L-Arginine concentration was not significantly different between HD patients with and without history of thromboembolic manifestations. Conclusion: Several abnormalities in amino acids were present in HD patients compared to controls. The mean serum L-arginine level was lower in 61.9% of HD patients than the mean of the controls with no significant difference. L-Arginine concentration was not significantly different between HD patients with and without history of thromboembolic manifestations. HD patients without history of thromboembolic manifestations had significantly lower glutamic acid concentrations and significantly higher phenylalanine concentrations than HD patients with history of thromboembolic manifestations.