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Papers In Press, published online ahead of print June 20, 2006
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Division of Genetic Epidemiology, Innsbruck Medical University, Innsbruck A-6020
Corresponding Author: Florian.Kronenberg{at}i-med.ac.at
Increased plasma concentrations of apolipoprotein A-IV (apoA-IV) in chronic renal disease suggest a metabolic role of the kidney for this anti-atherogenic protein. We therefore investigated patients with various forms of proteinuria and found increased serum concentrations of apoA-IV in 124 nephrotic patients compared to 274 controls (mean 21.9±9.6 vs. 14.4±4.0mg/dl, p<0.001)). Decreasing creatinine clearance showed a strong association with increasing apoA-IV levels. However, serum albumin levels significantly modulated apoA-IV levels in patients with low creatinine clearance resulting in lower levels of apoA-IV in patients with low compared to those with high albumin levels (21.4±8.6 vs. 29.2±8.4mg/dl; p=0.0007). Furthermore, we investigated urinary apoA-IV levels in additional 66 patients with a wide variety of proteinuria and 30 controls. Especially patients with a tubular type of proteinuria had significantly higher amounts of apoA-IV in urine than those with pure glomerular type of proteinuria and controls (median 45, 14 and 0.6 ng/mg creatinine, respectively). We confirmed these results in affected members of a family with Dents disease who are characterized by an inherited protein reabsorption defect of the proximal tubular system. In summary, our data demonstrate that the increase of apoA-IV caused by renal impairment is significantly modulated by low levels of serum albumin as a measure for the severity of the nephrotic syndrome. From the investigation of apoA-IV in urine as well as earlier immunohistochemical studies we conclude that apoA-IV is filtered through the normal glomerulus and is subsequently mainly reabsorbed by proximal tubular cells.
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B. C.H. Kwan, F. Kronenberg, S. Beddhu, and A. K. Cheung Lipoprotein Metabolism and Lipid Management in Chronic Kidney Disease J. Am. Soc. Nephrol., April 1, 2007; 18(4): 1246 - 1261. [Full Text] [PDF] |
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