Background/Purpose: Homocysteine is a proven prospective risk factor for stroke and arterial thrombosis in SLE. However, checking for homocysteine and treating high levels is actually discouraged, because randomized clinical trials in the general population did not show a reduction in coronary events.

Methods: 1623 SLE patients (92% female; 52% Caucasian and 40% African-American) were studied. For the first homocysteine measurement, 85.6% were below 15 umol/L. High levels were treated with folic acid or Folbic. We used GEE to estimate the association between homocysteine and the urine protein/cr ratio using serial tests of homocysteine.

Results: The same day homocysteine > 15 was associated with the same day urine protein/cr ratio (p=0.0008). Homocysteine was associated with serum creatinine (p>0.0001). Among 829 patients, 604 had at least two homocysteine measurements, 272 had three or more. A 10 umol/L decrease in homocysteine within a person corresponds to an average 0.011 (95% CI: 0.006 to 0.015) unit decrease in urine protein/creatinine ratio (P < 0.0001), after adjusting for sex and ethnicity. The association remained significant (0.004 (95% CI 0.002 to 0.007), P = 0.0005) when we only included patients with a first homocysteine greater or equal to 15 umol/L and a same day urine protein/creatinine ratio greater or equal to 0.2. In addition, the association was not changed if we adjusted for the serum creatinine.   Table 1. Association of a 10 umol/L Decrease in Homocysteine with Lower Urine Protein/Cr

Conclusion: High homocysteine levels, when treated, resulted in significant lowering of the urine protein/cr ratio, that was independent of serum creatinine.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-homocysteine-improves-urine-proteincr-ratio-in-sle/