Apolipoprotein-B-Containing Lipoproteins and the Progression of Renal Insufficiency

Abstract

Hyperlipidemia is associated with accelerated glomerular sclerosis in experimental renal insufficiency. To investigate whether the dyslipoproteinemia seen in human renal failure also influences the future course of renal insufficiency, we have correlated plasma levels of lipids and apolipoproteins at start of follow-up with the subsequent change in renal function in 34 adult patients with chronic renal disease. Nineteen patients had primary renal disease, and 15 patients had diabetic nephropathy. Except for antihypertensive therapy no specific treatment to modify the progression of the disease was given during the follow-up. The rate of progression was determined by repeated measurements of the glomerular filtration rate (GFR). The time of follow-up ranged from 12 to 91 months with an average of 39.7 ± 16.7 months. The mean initial GFR was 34.7 ± 13.9 ml/min× 1.73 m² body surface area and the average decline in renal function was -0.27 ± 0.26 ml/min/month. The entry levels of triglycerides (TG; p = 0.04), very-low-density lipoprotein cholesterol (p = 0.03), apolipoprotein-B (ApoB; p = 0.008) and systolic blood pressure (SBP; p = 0.04) were significantly correlated with the rate of progression. Among lipoprotein variables, ApoB showed the strongest correlation with the decline in GFR. Patients with a progressive course of their disease also tended to have initially higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (NS), whereas the initial plasma concentration of high-density lipoprotein cholesterol did not show an association with the progression of renal insufficiency. The rate of progression was shown to be much higher in patients with initially high levels of both ApoB and SBP than in patients with initially low levels of these variables. There was no difference between diabetic and nondiabetic patients with respect to initial ApoB and BP levels and the rate of progression. The results of this study suggest that altered lipoprotein metabolism has a significant effect on the progression of renal failure. In particular, increased plasma concentrations of ApoB-containing lipoproteins seem to be linked to a more rapid development of renal insufficiency, and the combination of dyslipoproteinemia and hypertension may act synergistically to promote the progression of chronic renal failure.

Increased Prevalence of Apolipoprotein E3/E4 Genotype among Swedish Renal Transplant Recipients

“…Early in the development of renal insufficiency, abnormalities in blood lipids can be seen, including increases in apo B concentrations and a reduction of the anti-atherogenic apo A-II/apo B ratio [27]. Samuelsson et al [28]found a strong negative correlation between apo B concentration and glomerular filtration rate in 34 patients with renal disease, of whom 15 had diabetic nephropathy. Another prospective study of 30 type I diabetics found a correlation between high cholesterol, triglyceride, and apo B levels and the rate of decline in renal function [29].…”

Plasma lipoproteins and the incidence of abnormal excretion of albumin in diabetic American Indians: The Strong Heart Study

“…In some prospective studies of people with Type I or Type II diabetes, total triglycerides [5,6], LDL cholesterol [6,7], total cholesterol [8±10] and apolipoprotein B [11] were risk factors for the progression of nephropathy. HDL cholesterol has not been reported as a risk factor [6, 7, 10±16] and no other lipid effect was found in several studies [12±18].…”

How to Avoid Delay in SLE Diagnosis and Management

“…There is a strong relation in LN patients between cholesterol concentration and proteinuria. There are several reports in non-diabetic renal disease with proteinuria that relate increase cholesterol and triglyceride to an increase in loss of renal function (Apperloo, de Zeeukw & de Jong,1994;Maschio et al, 1989;Samuelsson et al, 1993). Hydroxyl-3-methylglutaryl coenzyme A (HMG-CoA) inhibitors (statins) are beneficial in lowering low density lipoprotien (LDL) cholesterol.…”