Lipoprotein(a) Levels and Fibrinolytic Activity in Patients with Nephrotic Syndrome

Abstract

Recently there has been a renewed interest in the possibility that lipoprotein(a) -Lp(a) – may be important in the pathogenesis of thrombosis-related disease. In nephrotic syndrome, hyperlipidemia is a common finding, and thrombosis is a major complication. With this regard, if Lp(a) levels increase concomitantly with low-density lipoprotein and/or very-low-density lipoprotein levels in nephrotic syndrome, this may be considered a thrombogenic factor. To probe this possibility and to corroborate the relationship between Lp(a) and fibrinolytic profiles, we measured the Lp(a) levels in patients with nephrotic syndrome (n=43), in patients with chronic glomerulonephritis with less proteinuria than in nephrotic syndrome (n=28), and in healthy controls (n=50) and observed the relation between Lp(a) levels and tissue-type plasminogen activator (t-PA) activity, euglobulin fibrinolytic activity, and t-PA antigen. The Lp(a) levels were significantly higher in the patients with nephrotic syndrome as compared with both patients with chronic glomerulonephritis and healthy controls (p < 0.001). There was a direct correlation with serum cholesterol level (r=0.780; p = 0.0001), triglyceride level (r=0.445; p = 0.0001), and urine protein level (r = 0.675; p=0.0001) and a reverse correlation with serum albumin levels (r = 0.566; p = 0.0001). The Lp(a) levels showed a reverse correlation with t-pA activity (r = 0.627; p = 0.0001), total fibrinolytic activity in euglobulin fraction (r = 0.458; p = 0.0001), and t-PA activity divided by the t-PA antigen (r = 0.567; p = 0.0001), but no correlation with t-PA antigen. Our results suggest that Lp(a) may be an important thrombogenic factor in patients with nephrotic syndrome.

The Significance of Atherogenic Indices in Patients on Hemodialysis

“…Kronenberg et al [16] also reported that Lp(a) levels did not show any significant difference between diabetic and nondiabetic patients on HD. This may be explained as follows: In the end-stage diabetic nephropathy, most patients develop hypoproteinemia due to protein wasting and nephrotic syndrome in addition to DM [10,12,[17][18][19]. The induction of HD therapy in these patients may improve the 'nephrotic stage' and general condition, which might depress excessive hepatic synthesis of Lp(a).…”

Levels of lipoprotein(a), apolipoprotein B, and lipoprotein cholesterol distribution in IDDM. Results from follow-up in the Diabetes Control and Complications Trial

“…Significantly higher cholesterol levels are present in the more buoyant LDL fractions (fractions 12-18) of the intensively treated group. A trend can be seen toward lower cholesterol content in the intermediate-density lipoprotein (IDL) fractions (fractions [19][20][21][22][23][24][25][26][27][28][29][30] in the intensively treated group, although this did not reach statistical significance.…”

“…Lp(a) levels have been shown to be higher in familial hypercholesterolemia [13], chronic renal failure [14][15][16][17][18][19], and nephrotic syndrome [20][21][22][23][24][25], and lower levels have been reported in cirrhosis [26]. How Lp(a) levels might be affected by IDDM and its complications and whether Lp(a) contributes to CAD [27,28] in this population remain controversial.…”

Lipoprotein(a) Levels and Fibrinolytic Activity in Patients with Nephrotic Syndrome

“…Dear Sir, We have read with interest the original paper by Hong et al [1] about the relation ship between lipoprotein(a) levels and fibri nolytic activity in patients with nephrotic syndrome and we would like to add our experience on this subject.…”