Lipoprotein abnormalities as a risk factor for progressive nondiabetic renal disease

Renal disease is accompanied by characteristic alterations of lipoprotein m etabolism, which appear as a consequence of nephrotic syndrome or renal ins ufficiency and are primarily reflected in an altered apolipoprotein profile rather than elevated plasma lipid levels. Their full characterization requ ires identification of discrete lipoprotein particles. While nephrotic synd rome results in increased concentrations of both cholesterol- and triglycer ide-rich apoB-containing lipoproteins, renal insufficiency is characterized by an accumulation of intact or partially metabolised triglyceride-rich ap oB-containing lipoproteins. The dyslipidemia has been discussed as a contri butory factor for the progression of renal insufficiency through developmen t of glomerulosclerosis and tubulointerstitial lesions together with accele rated atherosclerosis. Several experimental studies have shown that hyperlipidemia accelerates ren al damage. Lipid-lowering treatment can reduce renal lesions and preserve r enal function. The documentation in human nondiabetic progressive renal ins ufficiency is more limited. We have found that increased concentrations of triglyceride-rich, but not cholesterol-rich, apoB-containing lipoproteins a re, associated with a more rapid loss of renal function. The underlying pat hophysiological mechanisms for the relation between triglyceride-rich apoB- containing lipoproteins and progression of renal insufficiency are not full y understood. Treatment with hypolipemic drugs may attenuate the renal dysl ipidemia, but thus far there have been no reports about controlled clinical trials testing the possible effect of such treatment on the progression of renal insufficiency. In summary, there is evidence to suggest that some sp ecific lipoprotein abnormalities are a risk factor for the progression of r enal dysfunction, but the final test of such assumptions still rests on the results of urgently needed controlled intervention studies.