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Nephrotic Syndrome, Steroid Therapy and Associated Cardiovascular Risk; is Annexin A5 a Biomarker?

Souparnika S, Benedicta D’souza, Vivian D’souza

Aims: Thromboembolism is one of the major complications affecting nearly 25% of Nephrotic Syndrome patients. Annexin A5 is a calcium dependent positively charged glycoprotein with potent anti-coagulant activity. Previous studies have reported elevated Annexin A5 levels immediately after Myocardial Infarction and its plasma level reflected the severity of myocardial damage. Cardiovascular abnormalities during Nephrotic Syndrome and the role of Annexin A5 as a cardiac risk factor have been studied here. Methods: 72 adult Nephrotic Syndrome patients were studied for the blood levels of Annexin A5, lipid profile, Atherogenic Index and LDL/Annexin A5 ratio. The results were compared to age and sex matched healthy controls. The patients started on steroid therapy and they were followed up for a period of ten months. 27 patients attained remission during the time period and all the biochemical assays were repeated. Results: Nephrotic Syndrome patients exhibited dyslipidemia along with elevated Annexin A5, Atherogenic Index, Total Cholesterol/HDL ratio and LDL/Annexin A5 ratio. Annexin A5 was not correlated to cardiovascular risk but LDL/Annexin A5 ratio positively correlated with Atherogenic Index. Dyslipidemia and elevated atherogenic risk persisted in patients who attained remission. Conclusions: Cardiovascular risk persisted during remission even after effective steroid therapy. LDL/Annexin A5 can be considered as a cardiovascular risk factor in Nephrotic Syndrome patients.