HYPERLIPIDEMIA IN CHILDHOOD NEPHROTIC SYNDROME

Hyperlipidemia is an important characteristic of nephrotic syndrome (N S). Elevation of plasma total cholesterol, or more specifically low-de nsity lipoprotein cholesterol, is the major lipid abnormality in NS, a lthough hypertriglyceridemia may develop as the disorder progresses. T he pathophysiology of nephrotic hyperlipidemia is complex. The prevail ing view is that both hepatic synthesis of lipids and of apolipoprotei ns is increased, and that the clearance of chylomicrons and very low-d ensity lipoproteins is reduced. The precise contribution of increased lipogenesis and decreased lipid catabolism to hyperlipidemia, and thei r relationship to urinary protein loss, hypoalbuminemia and reduced se rum oncotic pressure remain controversial. There are two potential ris ks of elevated plasma lipids: atherosclerosis and progression of glome rular injury. Although neither of these complications has been proved with certainty, there is growing evidence that both may be long-term c onsequences of NS. Therefore, the diagnosis and treatment of lipid abn ormalities, important aspects of the management of nephrotic children, is summarized here to provide pediatric nephrologists with an informe d choice.