Patients with
nephrotic syndrome have
multiple abnormalities of
lipoprotein metabolism, but the cause and exact nature of these abnormalities have not been established. In the present study we have determined the kinetics of plasma
low-density lipoprotein (
LDL)
apoB in seven nephrotic patients demonstrating an elevated
LDL apoB production rate (25.7 +/- 6.4 vs. 13.1 +/- 0.3 mgkg-1 day-1; P < 0.001) but a normal
LDL apoB fractional catabolic rate (FCR) (0.31 +/- 0.04 vs. 0.33 +/- 0.008 pools day-1; NS) compared with 41 healthy control subjects. However, two out of the seven patients had a markedly low
LDL apoB-FCR.
Serum albumin was inversely correlated with the
LDL apoB production rate (R = -0.82; P < 0.05). Plasma
lipoprotein (a) [Lp(a)] levels were significantly (P < 0.001) increased in the nephrotic patients compared with control subjects. Significant correlations were observed between log Lp(a) and
LDL apoB production rate (R = 0.90; P < 0.01),
VLDL-cholesterol (R = 0.95; P < 0.001) and VLDL-
triglycerides (R = 0.80; P < 0.05) respectively. In summary, the present study suggests that nephrotic hyperlipidaemia may be caused by at least two independent mechanisms. The elevated
LDL apoB production rate is highly correlated with the prevailing levels of
serum albumin, whereas some nephrotic patients seem to have a decreased
LDL apoB clearance, suggesting impaired
LDL receptor-mediated clearance. The present results also suggest that the elevated plasma Lp(a) levels in
nephrosis are related to an increased hepatic synthesis rather than a decreased catabolism of
lipoproteins.