Lipoprotein profiles in a heterogeneous group of patients with nephrotic syndrome

Lipoprotein composition was determined by ultracentrifugation in 13 unselected hospitalized patients with nephrotic syndrome (proteinuria 6.2 +/- 0.5 g/24 h) and compared with that of 13 healthy subjects. Plasma levels of cholesterol and triglycerides (TG) were 407 +/- 45 (mean +/- SE) and 285 +/- 35 mg/dl in the patients vs. 195 +/- 11 and 108 +/- 12 mg/dl in the control group. Type IIb was the only hyperlipoproteinemia pattern in 10 patients (77%). The protein component of very low density lipoproteins (VLDL) was the only slightly elevated, but cholesterol and TG were markedly increased in relation to protein. Low density lipoproteins (LDL) were considerably elevated, and their cholesterol and TG components rose in relation to protein. Of interest was a small but distinct rise in high density lipoproteins (HDL), which was not observed by other investigators studying patients mostly with higher proteinuria and VLDL elevations. The mean HDL/LDL cholesterol ratio, and apparent atherogenic index, was not significantly reduced. Both plasma cholesterol and TG were inversely related to plasma albumin. Plasma cholesterol and even HDL cholesterol were positively related to proteinuria. The finding that in nephrosis with moderate proteinuria all lipoproteins are elevated and enriched in their lipid content, and that HDL rise along with VLDL--contrary to their reciprocal behavior in other lipoproteinemias--indicates that the elevation was due to a universal increase in lipoprotein synthesis. With regard to atherogenicity of nephrosis, no salient, general lipoprotein-related change was discerned. An individual appraisal of lipoprotein composition, including the extent of urinary HDL loss, is suggested.