Possible role of high density lipoprotein in the progression of glomerulosclerosis

The collapsing variant of focal segmental glomerulosclerosis is a fulminant lesion characterized by rapid progression to end-stage renal disease. Substantial in vivo and in vitro evidence suggests that lipids, particularly low density lipoprotein (LDL), can contribute to the progression of glomerulosclerosis as they do in atherosclerosis. The nephrotic syndrome is typically associated with marked elevation of LDL and suppression of high density lipoprotein (HDL), abnormalities which may, accelerate both of these lesions. We report the case of a patient who presented with heavy proteinuria and hypertension and was found to have collapsing focal segmental glomerulosclerosis as well as, surprisingly, a markedly elevated HDL level. Despite the poor prognosis of this lesion, over a 3-year period the patient maintained normal renal function and has experienced a decline in her proteinuria to below-nephrotic levels while maintaining an elevated HDL level. Though this is only a single report, it may nevertheless be worthwhile to consider the possibility that HDL levels could potentially modulate the course of glomerular disease.