Correlation of total cholesterol and protein in urine in patients with the NEPHROTIC syndrome

Abstract

Zusammenfassnng. Bei 42 Patienten mit nephrotischem Syndrom wurde die Protein-und Cholesterinausscheidung im 24 Stundenurin gemessen. Die gefundene positive Korrelation (r--0,76, p<0,01) zwischen Cholesterin und Protein im Urin w/ire vereinbar mit einer gesteigerten glomerul/iren Filtration yon Plasmalipoproteinen als Ursache der Lipidurie beim nephrotischen Syndrom. Sehliisselwarter: Nephrotisches Syndrom -Gesamtcholesterin im Urin Protein im UrinSummary. The excretion of protein and cholesterol in 24 h urine was measured in 42 patients with the nephrotic syndrome. The finding of a positive correlation (r = 0.76, p < 0.01) between urinary cholesterol and urinary protein would be compatible with an enhanced glomerular filtration of plasma lip•proteins as the cause of lipiduria in the nephrotic syndrome. Key words: Nephrotic syndrome -Urinary total cholesterol -Urinary proteinLipiduria is a commonly emphasized component of the nephrotic syndrome and refers usually to the birefringent or anisotropic crystals found in the urinary sediment of these patients. These anis•tropic bodies have the typical "Maltese cross" appearance when viewed with a polarizing microscope and cholesterol esters have been identified as the major components of these elements [6, 8, 91. A positive correlation between urinary cholesterol and urinary protein has been reported in several studies [1, 6] but could not be confirmed by others [2]. Most authors agree that an increased glomerular permeability to lip•protein is probably necessary before appreciable amounts of lipid appear in the urine [1][2][3][5][6][7][8][9].However, in all the said former studies urinary cholesterol was determined using nonspecific analytical procedures, mainly colorirnetric methods.Therefore, we studied with a specific gasliquid chromatographic method, whether a positive correlation would exist between urinary protein and urinary cholesterol in patients with the nephrotic syndrome. Offprint requests to: Dr. D. Jfingst (address see page I216)A nephrotic syndrome was defined as a clinical state in which there is a combination of •edema, proteinuria and hypoproteinaemia, irrespective of the aetiology or any other clinical features. This definition stresses the occasional clinical similarities of many unrelated diseases.Total urinary cholesterol was analyzed in 2 ml aliquots of 24 h urine. After extraction with 6 ml ethyl acetate for 30 rain in a rotating system, the urinary phase was removed. The ethyl acetate extract was purified with alkali (2 ml 0.1 N NaOH) and water washings and dried under a stream of nitrogen. The residue was dissolved in 0.1 ml of the internal standard solution (10 mg 4-androstene-3,17-dione/dI isooctane), followed by GLC on a 180 cm 1% XE 60 column, i.d. 2 ram, temperature const. 220 ° C. Quantitation was performed due to the peak height ratio, since alterations of cholesterol and 4-androstenedione concentrations gave a linear response. For the determination of total urinary cholesterol hydrolysis of the dried extract with 0

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