Elevated plasma lipoprotein (a) in patients with the nephrotic syndrome

OBJECTIVE: To examine the influence of the nephrotic syndrome on lipoprotein(a) [Lp(a)], a plasma lipoprotein associated with atherosclerotic cardiovascular disease independently of low-density lipoproteins. Factors that modulate plasma Lp(a) concentrations are poorly understood. PATIENTS: A total of 62 patients: 47 with primary kidney disease and 15 with diabetic nephropathy. MEASUREMENTS: Lipoprotein(a) levels were determined by enzyme-linked immunosorbent assay. Because apo(a) phenotype has a significant effect on Lp(a) levels, apo(a) isoforms were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, Western blotting, and immunoblotting; the data were compared with a healthy control group. RESULTS: Nephrotic patients had significantly higher Lp(a) levels (mean, +/- SE, 69 +/- 10 mg/dL; median, 46 mg/dL, < 0.01) compared with 91 healthy controls (mean, 18 +/- 2 mg/dL; median 9 mg/dL). Sixty percent of the patients and 18% of the controls had values greater than 30 mg/dL. Lipoprotein(a) levels correlated significantly with apolipoprotein B, serum cholesterol, and low-density lipoprotein cholesterol but showed no correlation with creatinine, albumin, or proteinuria. Within all apo(a) isoform classes, higher concentrations of Lp(a) were seen in the nephrotic patients compared with controls (P < 0.05). Finally, in nine patients with primary kidney disease and elevated Lp(a) levels, remission of the nephrotic syndrome was induced using immunosuppressive drugs and Lp(a) values decreased dramatically (pretreatment mean, 90 +/- 15 mg/dL versus remission mean, 31 +/- 8 mg/dL). A decrease in Lp(a) levels was also observed when patients with diabetic nephropathy progressed to end-stage renal disease (nephropathy mean, 56 +/- 11 mg/dL versus dialysis mean, 34 +/- 10 mg/dL; n = 7). CONCLUSIONS: Most patients with the nephrotic syndrome have Lp(a) concentrations that are substantially elevated compared with controls of the same apo(a) isoform. Because Lp(a) concentrations are substantially reduced when remission of the nephrotic syndrome is induced, it is likely that the nephrotic syndrome results directly in elevation of Lp(a) by an as yet unknown mechanism. The high levels of Lp(a) in the nephrotic syndrome could cause glomerular injury as well as increase the risk for atherosclerosis and thrombotic events associated with this disorder

The Irish ‘Working Group on Information Literacy’ – Edging towards a national policy

The authors of this paper provide an overview of the activities of the Irish Working Group on Information Literacy (WGIL) and its role in advancing a national policy for information literacy in the Republic of Ireland. The study focuses on the work of the group during its lifetime including the various activities, marketing and advocacy initiatives and some of the challenges and issues the group faced, in particular, the diversity of the Irish library and information sector and the lack of an integrated approach for information literacy development. The study presents the findings of the report produced by WGIL entitled Library Association of Ireland: Working Group on Information Literacy: Review of Cross-Sector Activity 2006e2008 and Initial Recommendations for Further Action which reviewed best practices and information literacy activities in the various LIS sectors in the Republic of Ireland during a two-year period. The key recommendation of this report is for the leadership of the Library Association of Ireland to develop a national information literacy strategy that advocates for the importance of information literacy as a lifelong and transferable skill