Diagnostic Performances of Urinary Methylmalonic Acid/Creatinine Ratio in Vitamin B12 Deficiency
Sole measurement of plasma vitamin B12 is no longer enough to identify vitamin B12 (B12) deficiency. When plasma vitamin B12 is in the low-normal range, especially between 201 and 350 ng/L, B12 deficiency should be assessed by measurements of plasma homocysteine and/or plasma methylmalonic acid (MMA...
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MDPI AG
2020-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/8/2335 |
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| author | Sopak Supakul Floris Chabrun Steve Genebrier Maximilien N’Guyen Guillaume Valarche Arthur Derieppe Adeline Villoteau Valentin Lacombe Geoffrey Urbanski |
| author_facet | Sopak Supakul Floris Chabrun Steve Genebrier Maximilien N’Guyen Guillaume Valarche Arthur Derieppe Adeline Villoteau Valentin Lacombe Geoffrey Urbanski |
| author_sort | Sopak Supakul |
| collection | DOAJ |
| description | Sole measurement of plasma vitamin B12 is no longer enough to identify vitamin B12 (B12) deficiency. When plasma vitamin B12 is in the low-normal range, especially between 201 and 350 ng/L, B12 deficiency should be assessed by measurements of plasma homocysteine and/or plasma methylmalonic acid (MMA). However, these biomarkers also accumulate during renal impairment, leading to a decreased specificity for B12 deficiency. In such cases, urinary methylmalonic acid/creatinine ratio (uMMA/C) could be of interest, due to the stable urinary excretion of MMA. The objectives were to evaluate the influence of renal impairment on uMMA/C compared to plasma homocysteine and plasma methylmalonic acid, and to determine the diagnostic performances of uMMA/C in the diagnosis of B12 deficiency. We prospectively studied 127 patients with a plasma B12 between 201 and 350 ng/L. We noticed that uMMA/C was not dependent on renal function (<i>p</i> = 0.34), contrary to plasma homocysteine and plasma methylmalonic acid. uMMA/C showed a perspective diagnostic performance (AUC 0.71 [95% CI: 0.62–0.80]) and the threshold of 1.45 umol/mmol presented a high degree of specificity (87.9% [95% CI: 72.0–98.9]). In conclusion, uMMA/C is a promising biomarker to assess vitamin B12 status in doubtful cases, notably during renal impairment. |
| first_indexed | 2024-03-10T18:17:34Z |
| format | Article |
| id | doaj.art-1073f4fe5e59496cab3e1ea175200c34 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T18:17:34Z |
| publishDate | 2020-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1073f4fe5e59496cab3e1ea175200c342023-11-20T07:34:43ZengMDPI AGJournal of Clinical Medicine2077-03832020-07-0198233510.3390/jcm9082335Diagnostic Performances of Urinary Methylmalonic Acid/Creatinine Ratio in Vitamin B12 DeficiencySopak Supakul0Floris Chabrun1Steve Genebrier2Maximilien N’Guyen3Guillaume Valarche4Arthur Derieppe5Adeline Villoteau6Valentin Lacombe7Geoffrey Urbanski8Department of Internal Medicine, University Hospital, 49000 Angers, FranceDepartment of Biochemistry, University Hospital, 49000 Angers, FranceDepartment of Biochemistry, University Hospital, 49000 Angers, FranceDepartment of Internal Medicine, University Hospital, 49000 Angers, FranceDepartment of Internal Medicine, University Hospital, 49000 Angers, FranceDepartment of Internal Medicine, University Hospital, 49000 Angers, FranceDepartment of Internal Medicine, University Hospital, 49000 Angers, FranceDepartment of Internal Medicine, University Hospital, 49000 Angers, FranceDepartment of Internal Medicine, University Hospital, 49000 Angers, FranceSole measurement of plasma vitamin B12 is no longer enough to identify vitamin B12 (B12) deficiency. When plasma vitamin B12 is in the low-normal range, especially between 201 and 350 ng/L, B12 deficiency should be assessed by measurements of plasma homocysteine and/or plasma methylmalonic acid (MMA). However, these biomarkers also accumulate during renal impairment, leading to a decreased specificity for B12 deficiency. In such cases, urinary methylmalonic acid/creatinine ratio (uMMA/C) could be of interest, due to the stable urinary excretion of MMA. The objectives were to evaluate the influence of renal impairment on uMMA/C compared to plasma homocysteine and plasma methylmalonic acid, and to determine the diagnostic performances of uMMA/C in the diagnosis of B12 deficiency. We prospectively studied 127 patients with a plasma B12 between 201 and 350 ng/L. We noticed that uMMA/C was not dependent on renal function (<i>p</i> = 0.34), contrary to plasma homocysteine and plasma methylmalonic acid. uMMA/C showed a perspective diagnostic performance (AUC 0.71 [95% CI: 0.62–0.80]) and the threshold of 1.45 umol/mmol presented a high degree of specificity (87.9% [95% CI: 72.0–98.9]). In conclusion, uMMA/C is a promising biomarker to assess vitamin B12 status in doubtful cases, notably during renal impairment.https://www.mdpi.com/2077-0383/9/8/2335vitamin B12 deficiencyplasma homocysteineplasma methylmalonic acidurinary methylmalonic acidbiomarkerrenal impairment |
| spellingShingle | Sopak Supakul Floris Chabrun Steve Genebrier Maximilien N’Guyen Guillaume Valarche Arthur Derieppe Adeline Villoteau Valentin Lacombe Geoffrey Urbanski Diagnostic Performances of Urinary Methylmalonic Acid/Creatinine Ratio in Vitamin B12 Deficiency Journal of Clinical Medicine vitamin B12 deficiency plasma homocysteine plasma methylmalonic acid urinary methylmalonic acid biomarker renal impairment |
| title | Diagnostic Performances of Urinary Methylmalonic Acid/Creatinine Ratio in Vitamin B12 Deficiency |
| title_full | Diagnostic Performances of Urinary Methylmalonic Acid/Creatinine Ratio in Vitamin B12 Deficiency |
| title_fullStr | Diagnostic Performances of Urinary Methylmalonic Acid/Creatinine Ratio in Vitamin B12 Deficiency |
| title_full_unstemmed | Diagnostic Performances of Urinary Methylmalonic Acid/Creatinine Ratio in Vitamin B12 Deficiency |
| title_short | Diagnostic Performances of Urinary Methylmalonic Acid/Creatinine Ratio in Vitamin B12 Deficiency |
| title_sort | diagnostic performances of urinary methylmalonic acid creatinine ratio in vitamin b12 deficiency |
| topic | vitamin B12 deficiency plasma homocysteine plasma methylmalonic acid urinary methylmalonic acid biomarker renal impairment |
| url | https://www.mdpi.com/2077-0383/9/8/2335 |
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