LIPOPROTEIN(A) LEVELS AND FIBRINOLYTIC-ACTIVITY IN PATIENTS WITH NEPHROTIC SYNDROME

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, englobulin 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.