Comparison of Cardiac Risk Factors in Patients with Nephrotic Syndrome and Secondary Amyloidosis

Comparison of Cardiac Risk Factors in Patients with Nephrotic Syndrome and Secondary Amyloidosis

Proteinuria is an independent risk factor for cardiovascular diseases and for the increment of atherosclerotic mortality. Atherosclerotic risk factors are well known in the various types of nephrotic syndrome but there are only few studies comparing the same risk factors between the secondary amyloidosis and nephrotic syndrome patients those have exactly same 24- hour protein levels in the urine. According to theliterature, recent comparative studies have not shown the etiological differences of atherosclerotic risk factors in these two disease groups. The aim of this study was to investigate the risk factors caused byproteinuria on development of atherosclerosis and to determine the differences in these disease groups those were well- matched in age, gender, arterial blood pressure levels, glomerular filtration rate (GFR) and body mass index. These patients groups were chosen to have exactly the same 24- hour protein levels in urine. 29 patients with nephrotic syndrome, 30 patients with secondary amyloidosis and 30 people of control group were taken to the trial. C- reactive protein (CRP), fibrinogen, cholesterol, triglyceride, low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), lipoprotein -a [Lp(a)], apo- lipoprotein Al (apo Al), apolipoprotein B (apo B), apo- lipoprotein E (apo E), GFR and 24- hour protein in urine were compared between the patients and control groups. In the patients groups; cholesterol, triglyceride, LDL-C, Lp(a), apo A, apo B, apo E and fibrinogen levels were found much higher than the control group whereas HDL-C levels were lower (p

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  • 1. Berlyne GM, Mallick NP: Ischemic heart disease as a complication of nephrotic syndrome. Lancet:1969, 2;399-400.
  • 2. Jaap AJ, Erik SGS, and Ton JR: Endothelial function in proteinuric renal disease. Kidney Intl: 1999; 56 (Suppl. 71), S57-S61.
  • 3. Stephan R. Orth, and Eberhard Ritz: The Nephrotic syndrome. N Engl JMed:1998; 338,1202-1211.
  • 4. Robert R. L. Smith, Grover M. Hutchins: Ischemic heart disease secondary to amyloidosis of intramyocardial arteries. Am J Cardiology: 1979;44, 413-417.
  • 5. HamerJ.p.m., S. Janssen, M.H. Van Rijswijkand K.I.Lie: Amyloid cardiomyopathy in systemic non-hereditary amyloidosis. Eu Heart J: 1992;13, 623-627.
  • 6. David C. Wheeler, and David B. Bernard: Lipid abnormalities in the nephrotic syndrome: Causes, concequences, and treatment. American Journal of Kidney Disease: 1994;23, 331-346.
  • 7. J Radhakrishan, A.S. Appel, A. Valeri, and Gerald BA: The nephrotic syndrome, lipids and risk factors for cardiovascular disease. Am J Kidney Disease. 1993;22, 135-142.
  • 8. Srinivas KV, Neverov NI, Kolunduk NV, Tambovtseva EV, Kozlova RI: Blood lipids in renal amyloidosis. Urol Nefrol (Mosk): 1993; (1),28-31, (abstr).
  • 9. Kannel WB, Stampfer MJ, Castelli WP, Verter J: The prognostik significance of proteinuria. The Framingham study. AmHeart J: 1984;108,1347-1352.
  • 10. Karen EP, MartinB, John T, Vıdya MA, Gordon DOL, and Angela CS. Endothelial dysfunction and inflammation in asymptomatic proteinuria. Kidney Int: 2003; 63, 624-633.
  • 11. Christopher JD, Muriel JC, Michael M, J. Michael Boulton-Jones and Christopher JP: Increased atherogenicity of low —density lipoprotein in heavy proteinuria. Nephrol Dial Transplant: 1998; 13,1183-1188.
  • 12. OngajyoothL.Sirisalee K, Laohaphand T, Parichatiganond P, Shayakul C, Nilwarangkur S: Lipoprotein abnormalities in adult nephrotic syndrome. J Med Assoc Thai:1993; 76(9),512-20.
  • 13. Ordonnez JD, Hiatt RA, Killebrew EJ, Fireman BH: Theincreased risk of coronary heart disease associated with nephrotic syndrome. Kidney Int: 1992;44,638-642.
  • 14. Atman PO, Alaupovic P: Pathogenesis of hyperlipidemia in the nephrotic syndrome. Am J Nephrol:1990;10 (Suppl 1)69-75.
  • 15. Stenvinkel P, Berglund L, Ericsson S, Alvestrand A, Angelin B, Eriksson M. Low density lipoprotein metabolism and its association to plasma lipoprotein(a) in the nephrotic syndrome. Eur J ClinInvest: 1997;2,167-77.
  • 16. Christopher JD, Muriel JC, Michael C, J. Michael Boulton-Jones andChristopher JP: The atherogenic lipoprotein phenotype: small dense LDL and lipoprotein remnants in nephrotic range proteinuria. Atherosclerosis: 2001; 157,211-220.
  • 17. Veneracin GC, Nig F, Catherine AR, John L, Nancy RW, Frederick CD, andGodfrey SG: Influence of apoA-I and apoE on the formation of serum amyloid A-containing lipoproteins in vivo and in vitro. Journal of Lipid Research: 2004;45, 317-325.
  • 18. Apel GB, Valeri A, Appel AS, Blum C: The hyperlipidemia of the nephrotic syndrome. Am J Med: 1989;87 (5N), 45-50.
  • 19. Macrae F. Linton, and Sergio Fazio: A Pratical approach to risk assessment to prevent coronary artery disease and its complications. Am J Cardiol:2003;92(suppl), 19-26.
  • 20. Kronenberg F, Steinmetz A, Kostner GM, Dieplinger H: Lipoprotein(a) in health and disease. Crit Rev Clin Lab Sci: 1996;33(6),495-543.
  • 21. Ünlü Y, Karapolat S, Karaca Y, Kızıltunç A: Comparison of levels of inflammatory markers and hemostatic factors in the patients with and without periferal arterial disease. Thrombosis Research: 2005 (in press).
  • 22. J Radhakrishan, A.S. Appel, A. Valeri, and Gerald BA: The nephrotic syndrome, lipids and risk factors for cardiovascular disease. Am J Kidney Disease. 1993;22, 135-142.
  • 23. David C. Wheeler, and David B. Bernard: Lipid abnormalities in the nephrotic syndrome: Causes, concequences, and treatment. American Journal of Kidney Disease: 1994;23, 331-346.
  • 24. Simcha US, Reinhold PL, andYaacov M: Expression and function of serum amyloid A, a majoracut-phase protein, normal and disease states. Current opinion in hematology: 2000; 7, 64-68.
  • 25. Jiang W, Chen M, Huang J, Shang Y, Qin C, Ruan Z, Li S, Wang R, Li P, Huang Y, Liu J, Xu L. Proteinuria is independently associated with carotid atherosclerosis: a multicentric study. BMC Cardiovasc Disord. 2021 Nov 19;21(1):554.