FRI104 A Case Of Nephrotic Syndrome Presenting With Hyperlipidemia

Abstract

Abstract Disclosure: I.J. Romao: None. V. Taranto: None. M.H. Shanik: None. Introduction: Nephrotic syndrome is associated with increased risk of atherosclerosis, stroke and thromboembolism (1). These complications can be linked to an increase in total cholesterol, LDL and triglycerides levels that are seen in nephrotic syndrome. The aim of this presentation is to highlight the importance of considering nephrotic syndrome in the differential diagnosis of a significantly elevated lipid profile. Case presentation: A 40-year-old woman with a history of anxiety and hypothyroidism presented for evaluation of hyperlipidemia. Blood work revealed a total cholesterol of 636 mg/dL (<200), LDL was 502 mg/dL (<130), triglycerides 325 mg/dL (<150) and HDL 69 mg/dL (>40). She was started on Atorvastatin 80 mg daily. She developed nausea and achiness and was changed to Rosuvastatin 10 mg daily. The lipid profile improved but remained elevated with a total cholesterol of 351 mg/dL and LDL of 215 mg/dL. She was also noted to have elevated blood pressure and leg edema for the past 2 months. She was treated with Hydrochlorothiazide 12.5 mg daily that significantly helped with the leg swelling and weight loss. She was taking levothyroxine 100 mcg and her TSH was 1.95 uIU/mL (0.35-4.9). She did not have a family history of thyroid disease or hyperlipidemia. On exam her blood pressure was 136/100, pulse 108, weight 245 lbs., height 5’7”, respiratory rate 12. She had trace edema of her lower extremities. The significant elevation in cholesterol levels and her history of leg edema were suspicious for protein loss. A urine analysis showed elevated protein in the urine at 87 mg/dL (<15). She completed a 24-hour urine for protein that was markedly high at 16,740 mg/24 hours (<150) consistent with nephrotic syndrome. She was evaluated by a nephrologist who performed a renal biopsy that showed membranous glomerulonephritis and tubular atrophy. No secondary causes were found. Her diuretic was changed to Torsemide 10 mg daily and Lisinopril 10 mg daily was added. After several months her blood pressure normalized to 120/80 and her total cholesterol improved to 202 mg/dL, LDL was 98 mg/dL, triglycerides 229 mg/dL. Albumin level went from 1.8 to 3.8 g/dL (3.5-5.7). She had a marked decrease of protein in the urine from 216 to 35 mg/dL (<15). Conclusion: Nephrotic syndrome should be part of the differential diagnosis of any patient who has a history of significant hyperlipidemia. The abnormalities of serum lipids seen in nephrotic syndrome are largely due to the impaired clearance rather than biosynthesis and can lead to multiple complications. Making the diagnosis of nephrotic syndrome is very important as it is associated with significant cardiovascular and renal disease. 1. Agrawal S, Zaritsky JJ, Fornoni A, Smoyer WE, Dyslipidemia in nephrotic syndrome: mechanism and treatment. Shipra Agrawal, et al. Nature Reviews Nephrology 2018; 14:57. Presentation: Friday, June 16, 2023