state of the major circulating apolipoprotein B100-containing lipoproteins in patients with chronic renal failure and/or ischemic heart disease

The present study aimed at determining the major apolipoprotein B100 containing lipoproteins in CRF patients. These LDL subspecies are markers to lipid peroxidation, the key stone of atherosclerosis. Subjects and circulating levels of LDL-C/ HDL-C ratio, IDL [by sequential ultracentrifugation], Lp[a] [by ELISA] and MDA [by colorimetric method] were assessed in patients with CRF singly [30 cases] or combined with ischemic heart disease [15 cases] and in patients with sole IHD [15 cases]. Patients with CRF showed a significant increase in serum LDL-C concentrations and a significant decrease in HDL-C concentrations as compared with normals. Plasma IDL, Lp[a] and MDA median values were significantly higher than normal in the sole CRF, sole IHD and combined CRF with IHD. Serum TG and TC concentrations were significantly higher in patients with IHD singly than in sole CRF while HDL-C and LDL-C concentrations were similar in them. The serum levels of TC, TG, HDL-C and LDL-C in either IHD group and CRF+IHD group showed no significant differences in these groups. Also plasma Lp[a] and MDA concentrations were significantly higher in IHD patients than in controls. By multiple linear regression analysis, LDL-C/HDL-C ratio in all investigated cases was predictive indicator of abnormal IDL and Lp[a]. Conversely, Lp [a] value anticipated MDA concentrations. Although LDL-C/HDL-C ratio is known to influence atherogenesis, an avid relationship in between them is arguable due to different extrinsic and intrinsic confounding factors. However, measurement of LDL-C IHDL-C has been proposed as an appropriate first line investigations for diagnosis and therapeutic monitoring of IHD. Uremic dyslipidemia is not a simple association but promotes progression of CRF and accelerates atherosclerosis. High triglyceride-rich, apo B-containing lipoproteins [IDL and Lp[a]] may contribute avidly and independently to atheromatous process in chronic renal failure patients

state of plasma nitric oxide metabolites [NO-2 and NO-3] and endothelin-1 in patients with chronic renal failure and/or ischemic heart disease

the present study was designed to evaluate the endothelium potential vasodilatation and vasoconstriction major factors in groups of patients with CRF or IHD singly or combined. Patients and Cases eligible for inclusion in the present study were those with CRF solely [30 patients], IHD singly [15 patients] or combination of CRF with IHD simultaneously [15 patients]. The included controls [15 cases] were clinically healthy subjects who were highly matched to cases for age, gender and body weight. The designed biochemical analyses included: Plasma endothelin- 1 [ET-1] using enzyme immunometric assay [EIA] and plasma nitric oxide metabolites [NO[-2]/NO[-3] by photometric assay. The median plasma NO[-2] concentrations among single CRF, single IHD or combined CRF with IHD were not significantly different from those observed in controls. Alternatively the median concentration of plasma total NO[-3]] [NO[x]] and the ratio of NO[-3] to NO[-2] among CRF with or without IHD groups were significantly higher than controls. With regard plasma NO[x], its median concentration in IHD patients showed no significant difference from controls, but there was a significant decrease compared with single CRF or combined CRF with IHD. At the same time, statistically significant differences in the median plasma concentrations of ET- 1 between cases allocated in the three different diseased groups and control group were observed. Moreover, statistically significant higher median plasma concentrations of NO[x] and lower ET- 1 were noted in noncardiac CRF cases as compared with the nonuremic IHD patients. There was a positive relation between the plasma concentrations of NO[-2] and NO[x] in all, -studied groups and between plasma concentrations of NO[x] and ET- 1 in CRF patients whether single or combined with IHD. High ET- 1 and NO[x] levels were found in patients with advanced chronic renal failure with or without IHD, a feature that was not noted in uncomplicated IHD. Whether plasma NO[x] concentrations necessarily reflect production of the hemodynamically active component, NO is not yet settled. Therefore, plasma NOx levels, even when obtained under conditions of dietary NO[x] control, do not give stand-alone information about NO production, particularly when renal function is impaired. Although definitive proof that ET- 1 as a primary inducer of atherosclerosis is still elusive, it is likely that ET- 1- is at least an important contributor to the atherogenic process. Vascular endothelial cells in atherosclerosis may synthesize greater quantities of nitric oxide than nondiseased cells, but it is rapidly inactivated by oxidative reaction or converted to the toxic peroxynitrite