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Reduction in proteinuria attenuates hyperlipidemia in the nephrotic syndrome.

Hyperlipidemia in the nephrotic syndrome is characterized by increased synthesis of lipids as well as reduced removal of lipids from the blood. When rats with nephrotic syndrome are fed a 40% protein diet, urinary albumin excretion and rate of albumin synthesis increase. Serum cholesterol and triglyceride concentration increase as well. If the increase in albuminuria, but not the increase in the rate of albumin synthesis resulting from dietary protein augmentation, is prevented by the administration of enalapril, serum triglyceride and cholesterol concentration are not increased but are reduced nearly to within the normal range. Proteinuria, and not an increased rate of albumin synthesis, thus plays a causal role in nephrotic hyperlipidemia. Therapy directed at correcting altered glomerular permselectivity, while perserving an increased rate of albumin synthesis, may be effective in managing nephrotic hyperlipidemia.