Lipoprotein (a) as a Predictor of Steroid Dependence in Paediatric Steroid Sensitive Nephrotic Syndrome
Published: January 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/46262.14409
Surupa Basu, Sushmita Banerjee, Pranab Roy, Apurba Ghosh
1. Associate Professor and Head, Department of Biochemistry, Institute of Child Health, Kolkata, West Bengal, India.
2. Senior Consultant, Department of Pediatric Nephrology, Institute of Child Health, Kolkata, West Bengal, India.
3. Senior Consultant, Department of Molecular Biology, Institute of Child Health, Kolkata, West Bengal, India.
4. Director, Department of Pediatric Medicine, Institute of Child Health, Kolkata, West Bengal, India.
Correspondence
Surupa Basu,
11, Dr. Biresh Guha Street, Kolkata, West Bengal, India.
E-mail: basusurupa@gmail.com
Introduction: Lipoprotein a {Lp(a)} increases in Nephrotic Syndrome (NS). Although the majority of paediatric NS are steroid sensitive, relpase and steroid dependence are commonly seen in this cases. Lp(a) is an LDL-like lipoprotein that consists of an LDL particle to which the glycoprotein apolipoprotein(a) {apo(a)} is attached.
Aim: To evaluate the potential of Lp(a), measured on admission, for the prediction of relapse/steroid dependency.
Materials and Methods: Children (n=36) with first episode NS were recruited in this prospective observational case-control study and followed up for one year. They were tested at presentation for Lp(a) (mg/dL) and standard tests such as haemoglobin, albumin, protein, cholesterol, triglyceride, and urine protein. Children received standard therapy for NS, and were followed for a period of one year from diagnosis to record days to initial remission, relapse episodes, steroid dependence etc. Patients were categorised as: no relapse (NR), Infrequent Relapse (IFR), frequent relapse (FR) and Steroid Dependent (SD) as per standard definitions. Fifteen healthy volunteers were also tested for lipid profile and Lp(a) levels.
Results: Of 36 cases (median age 3 years, 19 males), there were 15NR, 7IFR, 2FR and 12SD. The mean Lp(a) of the NS group (165.2±120.4 mg/dL) was higher than controls (30.52±21.9 mg/ dL) (p<0.0001). All the lipid parameters except HDL-cholesterol were significantly higher in the NS group. Within the NS group, Lp(a) showed significant correlation (Spearman-rho) with albumin (p=0.0062,r=0.47), but no correlation with lipid parameters or urine protein. Comparison of Lp(a)levels in the NS groups revealed that the SD patients had a high Lp(a)(222.0±115.7 mg/ dL) compared to NR (129.7±120.1 mg/dL) (p=0.02).
Conclusion: Concentration of plasma Lp(a) in patients with SDNS was higher compared to patients who did not suffer any relapse, and this concentration may serve as a marker for prediction of SDNS.
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