Role of lipoproteins in progressive renal disease.

Abstract

Renal diseases are often associated with hyperlipoproteinemia and dyslipoproteinemia. Total serum cholesterol and triglycerides are increased in nephrotic syndrome regardless of etiology. Approximately 40 to 50% of patients with renal insufficiency requiring hemodialysis show hypertriglyceridemia and dyslipoproteinemia. During chronic hemodialysis, high doses of unfractionated heparin deplete post-heparin lipolytic activity and aggravate dyslipoproteinemia. Hypercholestrolemia and hyperlipoproteinemia are often encountered in patients taking glucocorticoids and cyclosporin A after renal transplantation. Observations in experimental animals and in patients with genetically determined and acquired hyperlipidemias suggest that lipids can damage the kidney and lead to glomerulosclerosis. In vitro cell-culture studies of human glomerular cells have been useful in providing information on lipid-induced glomerular damage. Thus, there are strong indications that lipoproteins may play a critical role in the development of mesangial cell damage and progressive renal disease. Therapeutic measures that reduce and correct dyslipoproteinemia in renal disease may have long-term beneficial effects on the amelioration of renal disease.