ACCUMULATION OF ATHEROGENIC REMNANTS AND LIPOPROTEIN(A) IN THE NEPHROTIC SYNDROME - RELATION TO REMISSION OF PROTEINURIA

Although lipoprotein abnormalities of the nephrotic syndrome are assum ed to be related to the presence of proteinuria, this topic has not be en investigated extensively. We measured lipoproteins from 19 nonuremi c patients during and after remission of the nephrotic syndrome in an effort to determine the extent of their putative atherogenicity. As ex pected, disturbances involved primarily the apoprotein B-containing li poproteins. No patient showed serum lipoprotein(a) [Lp(a)] <300 mg/L d uring the acute phase. Lp(a) concentrations correlated significantly w ith those of apoprotein B, and both values decreased dramatically with the remission of the nephrotic syndrome. Surprisingly, despite the re solution of proteinuria, concentrations of intermediate-density lipopr oteins and Lp(a) remained above normal in hypertriglyceridemic patient s, suggesting a residual effect of nephrosis in the overall lipoprotei n transport. Accumulation of atherogenic remnants should be considered a characteristic of the hyperlipidemia of the nephrotic syndrome, and aggressive treatment to reduce proteinuria is mandatory.