Serum and urinary high density lipoproteins in glomerular disease with proteinuria

Serum and urinary high density lipoproteins in glomerular disease with proteinuria. The serum lipoprotein concentrations, including high–density lipoprotein (HDL) subfractions and apolipoproteins A1 and B were measured in 21 patients (14 male and seven female) with nephrotic range proteinuria (>3g/24hr), well maintained renal function (creatinine clearance >35 mliter/min/1.73m2) and biopsy–proven primary glomerular disease. In these, and in a further five patients (creatinine clearance >15 mliter/min/1.73m2), urinary apolipoprotein A1 output was determined. Total HDL cholesterol was similar in patients and controls, but in male patients, HDL2 was low (0.54 ± 0.10 mmole/liter, mean ± SEM) compared to controls (0.75 ± 0.04 mmole/liter, P < 0.05) and HDL3 was high (0.81 ± 0.07 in patients and 0.63 ± 0.02 mmole/liter in controls, P < 0.01). In women, there was a similar tendency for HDL2 to be lower in patients (0.68 ± 0.18 mmole/liter) than in controls (0.85 ± 0.10 mmole/liter). Multiple regression analysis revealed that major determinants of the urinary apolipoprotein Al output were the urinary protein output and selectivity index (multiple r = 0.85). Furthermore, some patients lost apolipoprotein Al into their urine at rates indicating increased production of apolipoprotein Al in the nephrotic syndrome. The serum HDL subfraction concentrations in the nephrotic syndrome could be exaplained by a combination of increased HDL production and increased urinary loss of low molecular wt HDL