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Abstract: SA-PO367

Nuclear Magnetic Resonance Lipoprotein Analysis in Nephrotic Syndrome vs. Remission

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Hwang, Michael, National Institute of Diabetes and Digestive and Kidney Diseases Division of Intramural Research, Bethesda, Maryland, United States
  • Brown, Rebecca, National Institute of Diabetes and Digestive and Kidney Diseases Division of Intramural Research, Bethesda, Maryland, United States
  • Howard, Lilian, National Institute of Diabetes and Digestive and Kidney Diseases Division of Intramural Research, Bethesda, Maryland, United States
  • Waldman, Meryl, National Institute of Diabetes and Digestive and Kidney Diseases Division of Intramural Research, Bethesda, Maryland, United States
Background

Nephrotic syndrome (NS) is associated with lipid abnormalities characterized by elevations in total chol, low density lipoprotein (LDL-C), triglycerides (TG), lipoprotein(a) & apolipoproteins. While dyslipidemia improves with remission (R), unfavorable lipid profiles may persist beyond R & in those with residual proteinuria. These changes have not been well characterized. Comprehensive lipid analysis using nuclear magnetic resonance (NMR) may provide more information about atherogenicity than standard lipid testing during active NS (ANS) compared to R. NMR assesses lipoprotein (LP), particle(P) size, # & concentration, apolipoproteins & inflammation.

Methods

Patients with non-diabetic glomerular disease with paired NMR profiles (Vantera Clinical Analyzer) available during ANS & R (proteinuria >3.5 & <1 g/d, respectively) were included. Statistical comparisons were done for ANS vs R, & both ANS & R vs healthy controls using paired t tests or Wilcoxon tests.

Results

Table 1. 19 patients with membranous nephropathy analyzed (68% male, mean age: 53 y); 68% on lipid lowering drugs. As expected, ANS was associated with an atherogenic lipid profile that improved at R, including ↓ in TG, LDL-C, LDL-P # & apoB. However, TG rich LP remained ↑, notably large & very small TRLP (VS-TRLP). While HDL-C did not change, both HDL -P # & apoA1 ↓ vs ANS. GlycA remained ↑ at R despite normal CRP.

Conclusion

This NMR analysis provides a granular snapshot of LP during contrasting disease states. Despite overall improvement in lipids with R consistent with ↓ atherogenicity, the pattern of ↓ apoA1, total & large HDL with persistently ↑ TRLP (particularly highly atherogenic VS-TRLP) may suggest residual atherogenicity. The clinical significance of high GlycA, which reflects systemic inflammation, warrants further investigation in NS as a CVD risk predictor.

Funding

  • NIDDK Support