Cambruzzi E, Pêgas KL. Pathogenesis, histopathologic findings and treatment modalities of lipoprotein glomerulopathy: A review.
ACTA ACUST UNITED AC 2018;
41:393-399. [PMID:
30421781 PMCID:
PMC6788845 DOI:
10.1590/2175-8239-jbn-2018-0148]
[Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/27/2018] [Indexed: 11/24/2022]
Abstract
Lipoprotein glomerulopathy (LPG) is an uncommon cause of nephrotic syndrome
and/or kidney failure. At microscopy, LPG is characterized by the presence of
lipoprotein thrombi in dilated glomerular capillaries due to different ApoE
mutations. ApoE gene is located on chromosome 19q13.2, and can be identified in
almost all serum lipoproteins. ApoE works as a protective factor in
atherosclerosis due its interaction with receptor-mediated lipoprotein clearance
and cholesterol receptor. Most common polymorphisms include ApoE2/2, ApoE3/2,
ApoE3/3, ApoE4/2, ApoE4/3, and ApoE4/4. All age-groups can be affected by LPG,
with a discrete male predominance. Compromised patients typically reveal
dyslipidemia, type III hyperlipoproteinemia, and proteinuria. LPG treatment
includes fenofibrate, antilipidemic drugs, steroids, LDL aphaeresis, plasma
exchange, antiplatelet drugs, anticoagulants, urokinase, and renal
transplantation. Recurrence in kidney graft suggests a pathogenic component(s)
of extraglomerular humoral complex resulting from abnormal lipoprotein
metabolism and presumably associated to ApoE.
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