Dyslipidemia acts as a close link between cardiovascular risk and renal progression in nephrotic children

Background: Hyperlipidemia (HLP) is one of the cardinal manifestations of primary nephrotic syndrome (PNS). More importantly, HLP appears to act as a close link between cardiovascular risk and renal progression in nephrotic children. However, until recently, little information based on clinical and biochemical evidence was available to support this hypothesis.

Objective: We investigated the linkage between cardiovascular risk and renal progression of nephritic syndrome in children.

Methods: Three hundred seventy eight PNS children and 200 healthy volunteers were recruited into this study. Fasting serum levels of lipoprotein (a) [Lp(a)], cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), blood urea nitrogen (BUN), and creatinine (Cr) were measured. Serum LDL and estimate glomerular filtration rate (eGFR) were calculated by the Friedewald formula and the Schwartz formula respectively.

Results: Serum concentrations of Lp(a), TC, TG, HDL, LDL, and apoB were higher in the PNS than in the control group (p <0.05). Two hundred seventy three and 63 patients suffered from dyslipidemia and renal dysfunction to some extent, and the prevalence rates were 72.2% and 16.7%. More specifically, the most prevalent type of HLP was [TC‘!] with a constituent ratio of 49.1%, and the most prevalent type of renal dysfunction was [eGFR“!] with a constituent ratio of 76.2%. PNS children undergoing renal dysfunction exhibited significantly higher Lp(a) and TG concentrations than those with normal renal function (p <0.05). PNS children suffering from HLP had significantly higher BUN and lower eGFR levels than those with normal serum lipids (p <0.05). Serum Lp(a) was negatively correlated with eGFR (r = -0.36, p <0.05) in nephrotic children. In addition, Serum TG was also negatively correlated with eGFR (r = -0.45, p <0.05), While positively correlated with BUN (r = 0.43, p <0.05) in nephrotic children.

Conclusions: Lipid abnormalities may parallel with the reduction in renal function. On the other hand, the upregulations of serum lipid profiles, especially to Lp(a) and TG levels, can indeed accelerate cardiovascular risk in PNS children.