nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2021-25-1-31-46nefr-1929Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESЛипопротеин(а) и заболевания почекLipoprotein(a) and kidney diseaseshttps://orcid.org/0000-0002-5893-3191ПятченковМ. О.PyatchenkovM. O.

Пятченков Михаил Олегович - кандидат медицинских наук.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6, Тел.: +7 (812) 5424314

Mikhail O. Pyatchenkov - PhD, Department of nephrology and blood purification

194044, St. Petersburg, Phone: +7 (812) 5424314

pyatchenkovMD@yandex.ruhttps://orcid.org/0000-0002-9455-1043РумянцевА. Ш.RumyantsevA. Sh.

Профессор Румянцев Александр Шаликович - докторр медицинских наук, Санкт-Петербургский ГУ  кафедра факультетской терапии; кафедра пропедевтики внутренних болезней Санкт-Петербургский ГМУ им. акад. И.П. Павлова.

199106, Санкт-Петербург, 21-я линия В.О., д. 8а; 197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8, Тел.: +7(812)326-03-26. Тел.: +7(812)234-01-65

Alexandr Sh.Rumyantsev MD - PhD, DMedSci, Department of Faculty therapy St. Petersburg University

199106, St. Petersburg,  Phone: +7 (812) 3260326

rash.56@mail.ruhttps://orcid.org/0000-0001-6549-3991ЗахаровМ. В.ZakharovM. V

Доцент Захаров Михаил Владимирович - кандидат медицинских наук.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6, Тел.: +7 (812) 5424314

Mikhail. V. Zakharov - PhD, Department of nephrology and blood purification

194044, St. Petersburg, Phone: +7 (812) 5424314

vmeda_12@mil.ruhttps://orcid.org/0000-0002-3045-1721ЩербаковЕ. В.SherbakovE. V.

Щербаков Евгений Вячеславович

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6, Тел.: +7 (812) 5424314

Evgeniy V. Sherbakov - Department of nephrology and blood purification

194044, St. Petersburg, Phone: +7 (812) 5424314

evgenvmeda@mail.ruhttps://orcid.org/0000-0002-0421-3797БельскихА. Н.BelskykhA. N.

Профессор Бельских Андрей Николаевич - чл.-кор. РАН.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6, Тел.: +7 (812) 5424314

Andrei N. Belskykh - professor, Corresponding Member, Russian Academy of Sciences,  Department of nephrology and blood purification

194044, St. Petersburg, Phone: +7 (812) 5424314

vmeda_12@mail.ruВоенно-медицинская академия им. С.М. КироваРоссияMilitary Medical Academy S.M. KirovRussian FederationСанкт-Петербургский государственный университет; Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссияSt. Petersburg University; Pavlov First Saint Petersburg State Medical UniversityRussian Federation2021210120212513146Copyright © Пятченков М.О., Румянцев А.Ш., Захаров М.В., Щербаков Е.В., Бельских А.Н., 20212021Пятченков М.О., Румянцев А.Ш., Захаров М.В., Щербаков Е.В., Бельских А.Н.Pyatchenkov M.O., Rumyantsev A.S., Zakharov M.V., Sherbakov E.V., Belskykh A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1929

Липопротеин(а) [Лп(а)] представляет собой подкласс липопротеинов, состоящий из богатой холестерином частицы липопротеина низкой плотности (ЛПНП) с одной молекулой аполипопротеина В100, ковалентно связанной дисульфидным мостиком с уникальным гидрофильным высокогликозилированным белком, называемым аполипротеином a [апо(а)]. К настоящему времени имеется достаточно данных, чтобы рассматривать повышение уровня Лп(a) как причинный и независимый фактор риска сердечно-сосудистых заболеваний (ССЗ) и кальцинирующего стеноза аортального клапана (КСАК). Содержание Лп(a) в плазме крови может колебаться в широком диапазоне, что преимущественно определяется генетическими факторами. Повышение уровня Лп(a) затрагивает до 30 % населения во всем мире, однако данной категории липидных расстройств в настоящее время не уделяется должного внимания. Определение уровня Лп(a) не входит в стандартный липидный профиль, поэтому значительное количество лиц с гиперлипопротеи-немией (а), которые потенциально могли бы получить пользу от лечения, остается недиагносцированными. Определенные ограничения по-прежнему связаны с отсутствием стандартизированного метода измерения концентрации Лп(a) и консенсуса в отношении оптимальных его уровней в плазме крови. Несмотря на наличие ограниченных, но статистически значимых данных, свидетельствующих о благотворном влиянии его снижения на клинические исходы, нет единства представлений об оптимальных мерах нормализации уровня Лп(a) в плазме крови. Содержание Лп(a) в сыворотке крови отражает баланс между его синтезом, происходящим в печени, и катаболизмом, в котором, по мнению ряда авторов, значимую роль играют почки. Увеличение содержания Лп(a) отмечается уже на ранних стадиях хронической болезни почек (ХБП), а пациенты с нефротическим синдром имеют четырехкратное повышение Лп(a) по сравнению со здоровыми лицами. Тем не менее, до конца остается не ясным, в какой степени повышенные уровни Лп(a) будут влиять на сердечно-сосудистый риск у больных с нефропатиями. В данной статье представлены основные сведения относительно взаимосвязи между содержанием Лп(a), нарушениями функции почек и повышенным риском неблагоприятных кардиоваскулярных событий.

Lipoprotein(a) [Lp(a)] is a subclass of lipoproteins consisting of a cholesterol-rich low-density lipoprotein (LDL) particle with a single apolipoprotein B100 molecule covalently bound (via a disulfide bridge) to a unique hydrophilic high-glycosylated protein called apolipoprotein a [apo(a)]. To date, there is sufficient evidence to consider an increase Lp(a) level as a causal and independent risk factor for cardiovascular disease and calcifying aortic valve stenosis. Plasma concentration of Lp(a) can vary in a wide range, which is mainly determined by genetic factors. Up to 30 % of the world's population has an elevated Lp(a) level, but this category of lipid disorders has not been currently receiving adequate attention. Determining the Lp(a) plasma concentrations is not included in the standard lipid profile, so a significant number of individuals with hyperlipoproteinemia(a) who could potentially benefit from treatment remain undiagnosed. Certain significant obstacles are still associated with the lack of standardized assay for measuring Lp(a) concentrations and a consensus on its optimal levels in blood plasma. Although some limited but statistically significant data suggest a possible benefit of lipoprotein(a) lowering on cardiovascular outcomes, no specific recommendations were made for the management of that dyslipidemia in the latest guidelines. Plasma Lp(a) levels reflect a balance of Lp(a) synthesis, which occurs in the liver, and catabolism, which is thought to involve the kidney. Lp(a) concentration begins already to increase in the earliest stages of chronic kidney disease, and patients with nephrotic syndrome have a four-fold elevated Lp(a) in comparison to healthy individuals. However, it remains unclear if elevated Lp(a) levels affect cardiovascular risk in patients with kidney diseases. This article summarizes the main data regarding the relationship between Lp(a) content, impaired renal function, and an increased risk of adverse cardiovascular events.

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The authors declare that there are no conflicts of interest present.