Decreased plasma lecithin:cholesterol acyltransfer and associated changes in plasma and red cell lipids in uraemia

Plasma lipids, lecithin:cholesterol acyltransferase (LCAT) activity and erythrocyte lipid composition were compared for a group of newly diagnosed uraemic patients and a group of healthy subjects. Plasma triacylglycerol was increased and both total and high-density lipoprotein (HDL) cholesterol were decreased. A lower percentage of total cholesterol in patients' plasma was in the esterified form and plasma values of the phospholipid, lysolecithin, were also lower. The plasma LCAT activity of uraemic patients, whether expressed as nmol or percentage of cholesterol esterified per hour, was significantly lower than for normals. Both LCAT activity and lysolecithin in uraemic plasma were inversely correlated with the concentration of urea. The lipid composition of erythrocytes from patients was also abnormal, with both free cholesterol and lecithin being increased. These results are consistent with the occurrence of an acquired deficiency of LCAT in uraemia, comparable to that previously described in hepatic disease. The LCAT enzyme is secreted by the liver, and the inverse correlation noted in this study between LCAT activity and urea suggests that the increased urea in renal disease may inhibit the synthesis and secretion of the enzyme by the liver. The resulting reduction in LCAT activity may lead to the accumulation of cholesterol and lecithin in cell membranes and contribute to the overall pathophysiology of renal disease.