Lipid abnormalities in nephrotic syndrome
- Jai Radhakrishnan, MD, MS
Jai Radhakrishnan, MD, MS
- Professor of Medicine
- Columbia University Medical Center
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- Brad H Rovin, MD
Brad H Rovin, MD
- Section Editor — Glomerular Diseases
- Professor of Medicine and Pathology
- The Ohio State University College of Medicine
Abnormal lipid metabolism is common in patients with renal disease [1-6]. This effect is most prominent in the nephrotic syndrome, where marked elevations in the plasma levels of cholesterol, LDL, triglycerides and lipoprotein(a) often occur [1-5,7,8]. Total HDL cholesterol levels are usually normal or reduced in the nephrotic syndrome and there is often a pronounced decline in the cardioprotective HDL2 fraction. The mechanism by which this occurs is unclear, but elevations in the plasma concentration of cholesteryl ester transfer protein in nephrotic patients may contribute by shuttling cholesteryl esters from HDL2 to very low-density lipoproteins (VLDL) [9,10].
The concentration of plasma apolipoproteins in the nephrotic syndrome generally reflects the alterations in lipoprotein metabolism. Thus, there are elevated levels of apo B, C-II, and E, which are associated with VLDL and LDL; on the other hand, the levels of the major apolipoproteins associated with HDL, apo A-I and A-II, are usually normal . A review of the functions of the different apolipoproteins is discussed separately. (See "Lipoprotein classification, metabolism, and role in atherosclerosis".)
This topic will review the pathogenesis and treatment of lipid abnormalities in patients with the nephrotic syndrome. The pathogenesis and significance of lipid abnormalities in patients with chronic kidney disease and following kidney transplantation are discussed separately. (See "Indications for statins in nondialysis chronic kidney disease" and "Lipid abnormalities after renal transplantation".)
Marked hypercholesterolemia is common in patients with the nephrotic syndrome:
●Among 207 adults with nephrotic syndrome due to nondiabetic renal disease (mean proteinuria 7.2 g/24 hours), the mean total cholesterol concentration was 302 mg/dL (7.8 mmol/L) 
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