Nephrotic syndrome is characterized by increased triglycerides resulting from decreased clearance of VLDL and chylomicrons. These triglyceride-rich lipoproteins are structurally altered by interaction with HDL derived from animals with proteinuria and not as a consequence of hypoalbuminemia. HDL isolated from rats with massive proteinuria is depleted in apolipoprotein E (apoE). It is unknown at what threshold of urinary albumin loss HDL structure is altered, and it is unknown what effects proteinuria has on apolipoproteins other than apoE. Two models of albuminuria were used in Sprague-Dawley rats: Adriamycin and passive Heymann nephritis (HN). The adriamycin group was divided into minimal albumin excretion (MAE) and intermediate albumin excretion (MAE, 1 to 40; intermediate albumin excretion, 60 to 210 mg/d per 100 g body wt). Urinary albumin excretion exceeded 300 mg/d per 100 g body wt in the HN rats. HDL apolipoprotein composition was analyzed with SDS-PAGE densitometry and liquid chromatography-time of flight mass spectrometer mass spectrometry. HDL apoA-IV content relative to apoA-I was reduced at all levels of albuminuria (P < 0.0001). ApoE was not reduced in MAE but was significantly reduced in IAE (72%; P < 0.001). By contrast, apoA-II and apoC-III were each significantly increased with increasing UAE. ApoA-IV and apoE were decreased to approximately 10% of control in HDL isolated from rats with HN, whereas apoA-II, apoC-II, and apoC-III were each significantly increased relative to apoA-I. HDL is structurally altered by levels of albuminuria that are insufficient to change serum albumin levels and is progressively altered as albuminuria increases.J H yperlipidemia in the nephrotic syndrome is a result of increased synthesis (1,2) and decreased catabolism (1,3,4). VLDL levels are increased predominantly as a consequence of decreased catabolism both in rats with the nephrotic syndrome (4) and in humans (5). VLDL from nephrotic rat plasma does not bind normally to vascular endothelial cells, a consequence of reduced apolipoprotein E (apoE) content. Nascent VLDL functions normally when secreted by nephrotic livers but acquires a structural and functional defect through interaction with nephrotic HDL after VLDL secretion (6). The alteration in HDL structure and function results directly from proteinuria (3,6) and not from hypoalbuminemia.We have shown that defective clearance of VLDL in nephrotic rats requires interaction with HDL from proteinuric animals and that hypoalbuminemia does not deleteriously affect HDL structure. Although we have analyzed the effect of nephrotic range albuminuria on HDL structure, the effects of lesser amounts of albuminuria have not been well examined. Even small amounts of albuminuria are associated with increased relative risk for vascular disease in both diabetes (7,8) and hypertension (9,10). This association is generally believed to reflect underlying endothelial dysfunction in patients with microalbuminuria, causing both the renal albumin leak and the association with vasc...