POTENTIAL ROLE OF LIPIDS IN THE PROGRESSION OF DIABETIC NEPHROPATHY

Dyslipoproteinemia in non-insulin-dependent diabetes mellitus (NIDDM) is an important risk factor in the development of atherosclerosis and glomerulosclerosis. The lipid profile of NIDDM patients is characteriz ed by elevated serum triglycerides and VLDL levels and reduced HDL cho lesterol levels. Serum LDL levels may be elevated as well in some pati ents with NIDDM, but several alterations in the biochemical and physic al properties of LDL particles are more characteristic resulting in re duced receptor specific uptake of these lipoproteins. Non-enzymatic gl ycosylation of LDL and augmented oxidation is common in diabetic patie nts making lipoproteins susceptible for uptake by the macrophage scave nger receptors and thus leading to foam cell formation and further glo merular damage. A reduction in the progression of diabetic nephropathy by lowering proteinuria and thereby serum cholesterol during treatmen t with ACE-inhibitors demonstrates the importance of such a therapy. T he multiple factors involved in the pathogenesis of diabetic nephropat hy are difficult to evaluate in regard to their individual contributio n. Nevertheless antiproteinuric and lipid lowering therapy can be expe cted to reduce vascular damage and the progression of diabetic nephrop athy.