Introduction Cardiovascular diseases (CVD) are the main causes of morbidity and mortality in kidney renal transplant recipients (RTR). Several epidemiologic prospective studies have provided strong evidence that hyperhomocysteinemia (HHC) is an important and independent risk factor for CVD.

Objective Evaluate by high-resolution B-mode ultrasonography the carotid intima–media thickness (cIMT), an early sign of atherosclerosis, and to compare the difference between patients with normal homocysteine and HHC.

Methods We investigated 25 RTR pediatrics and young adults (0–19 years old). All subjects underwent cardiovascular risk factor assessment including fasting homocysteine levels assay, and high-resolution B-mode ultrasonography to measure IMT of common carotid arteries, 6 months after renal transplant.

Results We observed higher IMT values of common carotid arteries in the HHC group, when comparing it with the group with normal homocysteine, but without statistical significance (0.059 vs 0.055 mm; p value = 0.4 – right carotid; 0.055 vs 0.054 mm; p value = 0.8 – left carotid). Values of IMT increase with age, homocysteine level and in males with statistical significance only on this last one (0.058 vs 0.052 mm; p value  = 0.03).

Conclusions A non-invasive ultrasound measure of IMT is a good and safe method to detect an early sign of atherosclerosis in RTR pediatric patients. HHC was associated with increased measures of IMT of common carotid arteries but more studies will be necessary to confirm its role.