Characteristics of Dyslipidemia in Primary Nephrotic Syndromes

Background Although it is not a criterion for diagnosis, dyslipidemia is frequently found in nephrotic syndrome (NS). Cholesterol, triglyceride, and low-density lipoprotein (LDL) are usually elevated in NS, and high-density lipoprotein (HDL) can be normal or minimally decreased. Dyslipidemia in NS has been studied in isolation of the underlying glomerulopathy, and the comparison of lipid values between membranous nephropathy (MN), minimal change disease (MCD), and focal segmental glomerulosclerosis (FSGS), is not well recognized. Methods Retrospective chart review of patients with NS from 2010 to 2022. Patients with primary MN, MCD, and primary FSGS were included. Lipid profile was reported at the time of NS diagnosis and 12 months later. We compared lipid values between three primary NS using Kruskal-Wallis and Mann-Whitney U tests. Results There were 409 patients diagnosed with NS. 284 patients were excluded due to insufficient data or a diagnosis of secondary NS. One hundred and twenty-five patients with FSGS, MN, or MCD were included: FSGS (52, 41%), MCD (31, 25%), and MN (42, 34%). The average age was 32 years, with 55 females (44%), and 79 received statins (56%). After adjustment for serum albumin and proteinuria, initial cholesterol and triglyceride levels were similar in the three NS groups (P>0.05). Low-density lipid (LDL) was 216 mg/dL, 201 mg/dL, and 178 mg/dL in FSGS, MCD, and MN, respectively; the difference was only in FSGS vs MN group (p=0.04). Initial HDL was 58 mg/dL, 77 mg/dL, and 50 mg/dL in FSGS, MCD, and MN respectively (p=<0.001), differences were in MCD vs FSGS, and MCD vs MN groups (p=0.001, and p=<0.001 respectively). After 12 months of follow-up, lipid values were similar in the three NS groups regardless of statin use.  Conclusion After adjustment for primary NS severity, cholesterol and triglyceride values were insignificantly different at the presentation of MN, MCD, and FSGS. HDL was significantly higher in MCD compared to MN and FSGS, and LDL was significantly higher in FSGS compared to MN. At the 12-month follow-up, statin use did not change lipid values.