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Factors involved in the hyperlipidemia of nephrosis have been studied in seven patients. The turnover of triglyceride was measured in plasma very low density lipoproteins after the injection of glycerol-(14)C. The turnover of esterified cholesterol was measured in whole plasma and in very low density lipoproteins after the injection of mevalonic acid-2-(3)H. Urine protein loss was found to be significantly correlated with the plasma concentrations of triglyceride and free cholesterol, suggesting that increasing loss of protein is associated with the formation of larger lipoproteins. Lactescent plasmas were found in the subjects with the greatest protein loss. The turnover rate of triglyceride tended to be higher among subjects with higher than with lower triglyceride concentrations and was on the average higher than among six normotriglyceridemic subjects. However, there was also evidence for decreased clearance of glyceride from plasma. The hypertriglyceridemia of nephrosis appeared to reflect both increased formation of glyceride and decreased removal of glyceride from plasma. The turnover of esterified cholesterol was significantly higher in whole plasma of nephrotic subjects than in normocholesterolemic nonnephrotic patients. Esterified cholesterol turnover in very low density lipoproteins was raised in the two subjects in whom a major part of total esterified cholesterol was carried in this lipoprotein fraction. These studies were repeated in one subject after remission was induced. The cessation of urinary loss of protein was associated with reductions in the concentrations and turnover of triglyceride and esterified cholesterol. The increased turnover of plasma lipids in nephrosis may reflect the general increase in the formation of protein.

Studies on the turnover of triglyceride and esterified cholesterol in subjects with the nephrotic syndrome