Lipoprotein Derangement during Steroid Treatment in Minimal-Change Nephrotic Syndrome

Abstract

To study the pathophysiology of hyperlipidemia in nephrotic syndrome, we compared lipid metabolism in the nephrotic stage (stage 1) and in stage 2, when albuminuria had subsided, in 11 patients with minimal-change disease treated with corticosteroid. High-density lipoprotein (HDL) levels were decreased and HDL contained more cholesterol and triglyceride per unit of protein in stage 1 in the patients than in age-matched healthy controls. The urinary protein level was positively correlated only with low-density lipoprotein (LDL) levels, suggesting that the increased albumin clearance stimulated LDL production. Serum cholesterol levels were positively correlated with apolipo-protein E levels and were negatively correlated with lecithin-cholesterol acyltransferase activity in the nephrotic stage; the opposite correlations were seen in controls. Although triglycerides in HDL had normalized at stage 2, triglycerides in LDL and very-low-density lipoprotein did not return toward normal until stage 3, when serum cholesterol levels were normalized.

Direct Method for the Measurement of Low-Density Lipoprotein Cholesterol Levels in Patients with Chronic Renal Disease: A Comparative Assessment

“…Hyperlipidaemia is very frequently seen in chronic renal disease manifesting as nephrotic syndrome and/or uraemia [1, 2, 3]. In these cases, it is believed to be due to increased hepatic lipid and apoprotein synthesis, reduced rate of lipoprotein removal, reduced activity of lecithin-cholesterol acyltransferase, and reduced lipoprotein lipase activity [1, 2].…”

“…In these cases, it is believed to be due to increased hepatic lipid and apoprotein synthesis, reduced rate of lipoprotein removal, reduced activity of lecithin-cholesterol acyltransferase, and reduced lipoprotein lipase activity [1, 2]. The lipoprotein structure also tends to be abnormal in chronic renal disease, in that lipoproteins such as HDL and LDL have variations in proportions of cholesterol and triglycerides [3, 4] which appear to vary with the stage of development of renal functional impairment [3, 14]. The importance of hyperlipidaemia in these patients resides not only in its atherogenic potential [2], but additionally in its putative capacity to further damage glomerular structure and worsen renal failure [4].…”

“…Coronary heart disease (CHD) is an important cause of morbidity and mortality in patients with chronic renal disease – nephrotic syndrome and uraemia [1, 2, 3]. The high CHD prevalence in these patients is likely related to their high frequency of hyperlipidaemia [1, 2, 3].…”

“…The high CHD prevalence in these patients is likely related to their high frequency of hyperlipidaemia [1, 2, 3]. Accurate characterization of the degree and type of lipoprotein abnormalities should therefore be considered important in the management of patients with these chronic renal diseases to prevent CHD.…”

“…No such information is immediately available in patients with chronic renal disease who have also been described to have varying abnormalities in lipoprotein structure and composition [3, 14] and in whom, therefore, the Friedewald formula may also not be consistently applicable.…”