According to Gram Research analysis, children with active nephrotic syndrome have significantly elevated homocysteine in their urine and low levels of vitamin B12 and folic acid in their blood, but these abnormalities normalize when the disease goes into remission. A study of 79 children found that homocysteine levels were three times higher in newly diagnosed cases compared to healthy children, and vitamin B12 was substantially reduced across all active disease types.
A new study found that children with a kidney disease called nephrotic syndrome have unusual levels of a substance called homocysteine in their urine, along with low levels of vitamin B12 and folic acid. Researchers tested 60 children with different types of this disease and compared them to healthy children. The good news? When the disease got better, these vitamin levels returned to normal. This discovery might help doctors understand why some children with this kidney disease struggle and could lead to new ways to help them feel better.
Key Statistics
A 2026 study of 79 children published in the Journal of Tropical Pediatrics found that urinary homocysteine levels were significantly elevated in children with first-episode nephrotic syndrome compared to healthy controls, but normalized completely during disease remission.
According to research reviewed by Gram, children with active nephrotic syndrome had significantly lower serum vitamin B12 (P < 0.001) and folic acid (P = 0.004) levels compared to healthy children, with both vitamins rising substantially during remission.
A study of 60 children with nephrotic syndrome found that urinary homocysteine correlated strongly with urine protein loss (r = 0.479, P < 0.001), suggesting it may serve as a marker of kidney damage severity.
Research showed that vitamin B12 levels in children with nephrotic syndrome not only recovered during remission but actually exceeded normal control levels, indicating potential overcompensation during disease recovery.
The Quick Take
- What they studied: Whether children with nephrotic syndrome (a kidney disease that causes protein loss) have different levels of homocysteine (a body chemical) and B vitamins compared to healthy children
- Who participated: 79 children total: 60 with different types of nephrotic syndrome ranging from first-time cases to severe cases, plus 12 healthy children and 19 children whose disease was in remission
- Key finding: Children with active nephrotic syndrome had much higher homocysteine in their urine and much lower B12 and folic acid in their blood compared to healthy children, but these levels returned to normal when the disease improved
- What it means for you: If your child has nephrotic syndrome, doctors may want to monitor B vitamin levels and homocysteine as part of their care. These markers appear to improve when the disease is controlled, suggesting they could help track how well treatment is working.
The Research Details
Researchers recruited 79 children and divided them into groups: some with their first episode of nephrotic syndrome, some with occasional relapses, some with frequent relapses, some resistant to steroid treatment, plus healthy controls and children in remission. They measured three things in blood and urine samples: homocysteine (a compound linked to inflammation), vitamin B12, and folic acid. They tested children both when their disease was active and when it was in remission to see how these levels changed.
The study compared measurements between different disease groups and looked for patterns—for example, whether higher homocysteine connected to other kidney problems like protein loss. This approach helped researchers understand whether these vitamin and chemical changes were specific to certain types of the disease or happened in all cases.
Understanding what happens to B vitamins and homocysteine during nephrotic syndrome could help doctors better monitor disease activity and predict which children might need additional support. Since these levels normalized during remission, they might serve as useful markers to track treatment success without needing invasive tests.
This was a focused research study with a moderate sample size that measured specific biochemical markers. The researchers tested children at different disease stages and in remission, which strengthens the findings. However, the study was relatively small and focused on one population, so results would benefit from confirmation in larger, diverse groups. The clear statistical significance (P < 0.001) of main findings suggests the differences found were real, not due to chance.
What the Results Show
Children with first-episode nephrotic syndrome had significantly elevated homocysteine in their urine compared to healthy children and other disease groups (P < 0.001). When these children entered remission, their homocysteine levels dropped dramatically and matched healthy children’s levels.
Vitamin B12 and folic acid told a similar story: children with active nephrotic syndrome had much lower levels of both vitamins compared to healthy controls (B12: P < 0.001, folic acid: P = 0.004). Interestingly, when disease went into remission, B12 levels actually rose above normal control levels, suggesting the body was recovering and possibly overcompensating.
The researchers also found important connections: children with higher homocysteine tended to have lower blood protein and albumin (a key protein), but higher cholesterol and more protein in their urine. This suggests homocysteine increases when the kidney disease is most active and damaging.
The study revealed that different types of nephrotic syndrome showed similar patterns—all had elevated homocysteine and low B vitamins during active disease. The strength of the homocysteine-protein relationship (correlation of 0.479 with urine protein loss) was particularly strong, suggesting homocysteine might be a useful marker of kidney damage severity. The fact that vitamin levels normalized during remission suggests these changes are reversible and directly tied to disease activity rather than permanent damage.
This research builds on earlier findings that B vitamin metabolism is disrupted in nephrotic syndrome. Previous studies suggested protein loss in urine might affect vitamin absorption, and this study confirms that theory by showing vitamin levels recover when protein loss stops. The homocysteine findings are particularly novel, as less research has focused on this marker in children with this specific kidney disease.
The study included only 79 children from what appears to be a single center, which limits how broadly these findings apply to all children with nephrotic syndrome worldwide. The sample size was relatively small, especially for some disease subgroups. The study didn’t investigate why these vitamin changes happen or whether supplementing vitamins would help—it only measured levels. Additionally, the study didn’t follow children over time to see how quickly these markers change with treatment, which would be valuable for clinical use.
The Bottom Line
For children diagnosed with nephrotic syndrome, doctors should consider measuring B12 and folic acid levels as part of routine monitoring (moderate confidence). These measurements could help track disease activity and treatment response. Vitamin supplementation might be considered if levels are low, though this study didn’t test whether supplements help (low confidence without additional evidence). Regular monitoring during treatment and remission is recommended to ensure levels normalize.
Parents and doctors caring for children with nephrotic syndrome should pay attention to these findings. Children with newly diagnosed or frequently relapsing disease are most relevant. Nephrologists and pediatricians managing this condition should consider adding B vitamin screening to their monitoring protocols. Healthy children and those with other kidney diseases may not need this specific testing.
Based on this study, B vitamin levels appear to improve within weeks to months as the disease enters remission, though the exact timeline wasn’t specified. Homocysteine normalized during remission, suggesting improvements could be tracked relatively quickly—possibly within the timeframe of standard disease monitoring (weeks to months). Long-term follow-up would be needed to establish precise timelines.
Frequently Asked Questions
What is homocysteine and why does it matter in kidney disease?
Homocysteine is a chemical your body makes that can increase inflammation. In nephrotic syndrome, it builds up in urine when the disease is active, suggesting it may indicate kidney damage. When the disease improves, homocysteine levels drop back to normal.
Should my child with nephrotic syndrome take B vitamin supplements?
This study shows B vitamins are low during active disease, but doesn’t prove supplements help. Talk to your child’s nephrologist about testing B12 and folic acid levels and whether supplementation is appropriate for your child’s specific situation.
How quickly do B vitamin levels improve when nephrotic syndrome goes into remission?
This study showed that B vitamins normalize during remission but didn’t specify exact timelines. Improvement likely takes weeks to months as the disease improves. Your child’s doctor can track this with regular blood tests.
Can homocysteine levels predict whether my child’s nephrotic syndrome will get better?
This study shows homocysteine drops when disease improves, but doesn’t prove it predicts outcomes. It may help doctors track disease activity, but more research is needed to determine if it can predict which children will respond well to treatment.
Are these vitamin changes permanent or do they reverse with treatment?
These changes are reversible. The study found that B12, folic acid, and homocysteine all returned to normal levels during remission, suggesting they’re directly caused by active disease rather than permanent kidney damage.
Want to Apply This Research?
- Track B12 and folic acid lab values quarterly during active disease and every 6 months during remission. Record the date, value, and disease status (active vs. remission) to visualize whether levels are improving with treatment.
- Work with your child’s doctor to schedule regular lab work to monitor B vitamins. If supplementation is recommended, use the app to set reminders for daily vitamin doses and log when supplements are taken to ensure consistency.
- Create a dashboard showing B12, folic acid, and homocysteine trends over time alongside disease activity status. This visual comparison helps identify whether vitamin levels are improving as disease improves, and alerts you if levels aren’t normalizing as expected during remission.
This research describes biochemical changes in children with nephrotic syndrome but does not establish treatment recommendations. Parents should not start, stop, or change any medications or supplements based on this information without consulting their child’s nephrologist. B vitamin supplementation should only be considered under medical supervision after appropriate testing. This study was observational and does not prove that treating low B vitamins improves outcomes. Always work with your child’s healthcare team to make decisions about monitoring and treatment.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.