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.