Relation of hyperlipidemia in serum and loss of high density lipoproteins in urine in the nephrotic syndrome

Abstract

The mechanism leading to hyperlipidemia in the nephrotic syndrome is not fully understood but may be related in part to loss of high density lipoproteins in the urine of patients with nephrosis. To prove this hypothesis, we compared serum lipoprotein profiles with the excretion of high density lipoproteins in urine in 19 nephrotic patients. Serum cholesterol ranged from 19-152 (median value 45) mg/dl in very low density lipoproteins (VLDL), from 130-443 (median 186) mg/dl in low density lipoproteins (LDL) and from 19-64 (median 33) mg/dl in high density lipoproteins (HDL). Hyperlipoproteinemia was found in 17 patients, which was classified as phenotype IIa (Fredrickson) in 2, as phenotype IIb in 9 and as phenotype IV in 6 subjects. Two patients showed normal lipoprotein patterns. VLDL-and LDL-cholesterol were not found in detectable amounts in urine, whereas HDL-cholesterol was measured in low concentrations from 0.1-8.3 mg/24 h in all samples. There was no correlation between serum HDL-cholesterol and urinary HDL-cholesterol, but a positive correlation between serum LDL-cholesterol and urinary HDL-cholesterol (r = + 0.54, p < 0.05). However, the total amount of the daily urinary loss of HDL (< 1% of total plasma HDL) seems not to be sufficient to explain hyperlipoproteinemia in the nephrotic syndrome.Correspondence and reprint requests to:

Ultrasonographic Characteristics of Lipiduria in Clinically Normal Cats

“…Increased lipids in urine are also seen in patients with hyperlipidemia and chronic renal disease although not to the extent seen in people with nephrotic syndrome. Accumulation of lipid in the kidney in people has been shown to promote renal disease …”

Proteinurie

“…Belegt wurde eine verzögernde Wirkung einer solchen Eiweißrestriktion vor allem bei Patienten mit einer deutlich eingeschränkten Nierenfunktion (GFR unter 55 ml/min) [9,10]. Dazu gerechnet werden sollte die Menge des ausgeschiedenen Proteins.…”

Urinary Excretion of Apolipoproteins Bound to HDL-Like Particles in Rat Nephrotic Syndrome and Their Relation to Plasma HDL

“…In rat nephro sis invariably an increase in total circulating HDL was found in this and other studies [10,41], reflecting their enhanced hepatic synthesis, but no specific alterations have been hitherto reported. The daily urinary loss of HDL in human nephrosis was estimated to amount to < 1% of total plasma HDL [39]. A positive correlation was found between plasma and urine lipoprotein cholesterol [38].…”

“…In some nephrotic patient series with large VLDL elevation, a decrease in plasma HDL [4,37] or change in their apoprotein content [11,12] was reported, probably due to a shift of surface components from HDL to VLDL. In patients with mod erate VLDL elevation, no decrease and even an increase in plasma HDL was seen [38,39], The overall changes in the HDL may mask a specific redistribution of HDL lipid and protein components. It is pertinent that within hu man plasma HDL in nephrosis, a decrease in cholesterol and apo A-I content in the 'light' (d = 1.10-1.15 g/ml) HDL was observed together with an increase in 'heavy' (d = 1.15-1.21 g/ml) HDL subfraction [40].…”