Qualitative and Quantitative Analysis of Urinary Lipids in the Nephrotic Syndrome*

Klahr, Saulo; Tripathy, Kshetrabasi; Bolaños, Óscar

doi:10.1172/jci105639

Cited by 37 publications

(31 citation statements)

References 11 publications

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“…The lipid-protein correlations in our study were in good accordance to the results published by other authors [2,8,21,22]. Urinary total protein and urinary total cholesterol correlated positively (r = + 0.76, p < 0.01).…”

Section: Discussionsupporting

confidence: 93%

“…Only few studies exist which take the urinary lipid and protein excretion into account [8,11]. Using double immunodiffusion and lipoprotein-electrophoresis Kashyap et al found HDL in the urine of 9 nephrotic patients investigated.…”

Section: Discussionmentioning

confidence: 99%

“…In these patients an elevated excretion of urinary lipids has long been recognized [7,8] and it was suggested that loss of high density lipoproteins in urine might be related to h~er~poproteine~a in serum [9,10]. Although HDL was identified in urine of nephrotic patients [ll], quantitative measurements have not yet been done.…”

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confidence: 99%

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Relation of hyperlipidemia in serum and loss of high density lipoproteins in urine in the nephrotic syndrome

Jüngst

Caselmann

Kutschera

et al. 1987

Clinica Chimica Acta

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The mechanism leading to hyperlipidemia in the nephrotic syndrome is not fully understood but may be related in part to loss of high density lipoproteins in the urine of patients with nephrosis. To prove this hypothesis, we compared serum lipoprotein profiles with the excretion of high density lipoproteins in urine in 19 nephrotic patients. Serum cholesterol ranged from 19-152 (median value 45) mg/dl in very low density lipoproteins (VLDL), from 130-443 (median 186) mg/dl in low density lipoproteins (LDL) and from 19-64 (median 33) mg/dl in high density lipoproteins (HDL). Hyperlipoproteinemia was found in 17 patients, which was classified as phenotype IIa (Fredrickson) in 2, as phenotype IIb in 9 and as phenotype IV in 6 subjects. Two patients showed normal lipoprotein patterns. VLDL-and LDL-cholesterol were not found in detectable amounts in urine, whereas HDL-cholesterol was measured in low concentrations from 0.1-8.3 mg/24 h in all samples. There was no correlation between serum HDL-cholesterol and urinary HDL-cholesterol, but a positive correlation between serum LDL-cholesterol and urinary HDL-cholesterol (r = + 0.54, p < 0.05). However, the total amount of the daily urinary loss of HDL (< 1% of total plasma HDL) seems not to be sufficient to explain hyperlipoproteinemia in the nephrotic syndrome.Correspondence and reprint requests to:

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Relation of hyperlipidemia in serum and loss of high density lipoproteins in urine in the nephrotic syndrome

Jüngst

Caselmann

Kutschera

et al. 1987

Clinica Chimica Acta

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“…A positive correlation between urinary cholesterol and urinary protein has been reported in several studies [1, 6] but could not be confirmed by others [2]. Most authors agree that an increased glomerular permeability to lip•protein is probably necessary before appreciable amounts of lipid appear in the urine [1][2][3][5][6][7][8][9].However, in all the said former studies urinary cholesterol was determined using nonspecific analytical procedures, mainly colorirnetric methods.Therefore, we studied with a specific gasliquid chromatographic method, whether a positive correlation would exist between urinary protein and urinary cholesterol in patients with the nephrotic syndrome. …”

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confidence: 99%

Correlation of total cholesterol and protein in urine in patients with the NEPHROTIC syndrome

1980

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Zusammenfassnng. Bei 42 Patienten mit nephrotischem Syndrom wurde die Protein-und Cholesterinausscheidung im 24 Stundenurin gemessen. Die gefundene positive Korrelation (r--0,76, p<0,01) zwischen Cholesterin und Protein im Urin w/ire vereinbar mit einer gesteigerten glomerul/iren Filtration yon Plasmalipoproteinen als Ursache der Lipidurie beim nephrotischen Syndrom. Sehliisselwarter: Nephrotisches Syndrom -Gesamtcholesterin im Urin Protein im UrinSummary. The excretion of protein and cholesterol in 24 h urine was measured in 42 patients with the nephrotic syndrome. The finding of a positive correlation (r = 0.76, p < 0.01) between urinary cholesterol and urinary protein would be compatible with an enhanced glomerular filtration of plasma lip•proteins as the cause of lipiduria in the nephrotic syndrome. Key words: Nephrotic syndrome -Urinary total cholesterol -Urinary proteinLipiduria is a commonly emphasized component of the nephrotic syndrome and refers usually to the birefringent or anisotropic crystals found in the urinary sediment of these patients. These anis•tropic bodies have the typical "Maltese cross" appearance when viewed with a polarizing microscope and cholesterol esters have been identified as the major components of these elements [6, 8, 91. A positive correlation between urinary cholesterol and urinary protein has been reported in several studies [1, 6] but could not be confirmed by others [2]. Most authors agree that an increased glomerular permeability to lip•protein is probably necessary before appreciable amounts of lipid appear in the urine [1][2][3][5][6][7][8][9].However, in all the said former studies urinary cholesterol was determined using nonspecific analytical procedures, mainly colorirnetric methods.Therefore, we studied with a specific gasliquid chromatographic method, whether a positive correlation would exist between urinary protein and urinary cholesterol in patients with the nephrotic syndrome. Offprint requests to: Dr. D. Jfingst (address see page I216)A nephrotic syndrome was defined as a clinical state in which there is a combination of •edema, proteinuria and hypoproteinaemia, irrespective of the aetiology or any other clinical features. This definition stresses the occasional clinical similarities of many unrelated diseases.Total urinary cholesterol was analyzed in 2 ml aliquots of 24 h urine. After extraction with 6 ml ethyl acetate for 30 rain in a rotating system, the urinary phase was removed. The ethyl acetate extract was purified with alkali (2 ml 0.1 N NaOH) and water washings and dried under a stream of nitrogen. The residue was dissolved in 0.1 ml of the internal standard solution (10 mg 4-androstene-3,17-dione/dI isooctane), followed by GLC on a 180 cm 1% XE 60 column, i.d. 2 ram, temperature const. 220 ° C. Quantitation was performed due to the peak height ratio, since alterations of cholesterol and 4-androstenedione concentrations gave a linear response. For the determination of total urinary cholesterol hydrolysis of the dried extract with 0

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“…Only in patients with the nephrotic syndrome seems the positive correlation between urinary protein and urinary cholesterol to support the suggestions that enhanced filtration of plasma lipoproteins, especially the HDL-fraction, is responsible for increased lipiduria (Klahr et al 1967;de Mendoza et ai. 1976;Bing and Starup 1935).…”

Section: Total Urinary Cholesterol Mg/2z Hrmentioning

confidence: 85%

Studies on the clinical significance of nonesterified and total cholesterol in urine

Jüngst¹,

Wallner²,

Pickel³

et al. 1981

Klin Wochenschr

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Summary. Gas-liquid chromatographic determinations of nonesterified and total urinary cholesterol were performed in 137 normals, 264 patients with various internal diseases without evidence of neoplasias or diseases of the kidney or urinary tract, 497 patients with malignancies and 236 patients with diseases of the kidney, urinary tract infections or prostatic adenoma with residual urine. A normal range (mean_+ 2 SD) of 0.2-2.2 mg/24 hours nonesterified cholesterol (NEC) and of 0.3-3,0 rag/24 hours total cholesterol (TC) was calculated.Values of urinary cholesterol excretion were independent of age and sex and did not correlate with cholesterol levels in plasma. Patients with various internal diseases, without evidence of neoplasias nor diseases of the kidney or obstruction of the urinary tract, showed normal urinary cholesterol excretions, as did patients with infections of the urinary tract.However, elevated urinary cholesterol was found in patients with diseases of the kidney or urinary tract obstruction (prostatic adenoma with residual urine), malignant diseases of the urogenital tract and metastasing carcinoma of the breast. In patients with other malignant diseases urinary cholesterol was usually normal.Lesions of the urothelial cell membranes are considered to be the most likely cause of urinary cholesterol hyperexcretion. The clinical value of urinary cholesterol determinations as a possible screening test for urogenital carcinomas in unselected populations is limited by lacking specificity, expensive methodology and low prevalence of the mentioned carcinomas, although elevated urinary cholesterol excretions have been observed in early clinical stages of urogenital cancers.

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Qualitative and Quantitative Analysis of Urinary Lipids in the Nephrotic Syndrome*

Cited by 37 publications

References 11 publications

Relation of hyperlipidemia in serum and loss of high density lipoproteins in urine in the nephrotic syndrome

Relation of hyperlipidemia in serum and loss of high density lipoproteins in urine in the nephrotic syndrome

Correlation of total cholesterol and protein in urine in patients with the NEPHROTIC syndrome

Studies on the clinical significance of nonesterified and total cholesterol in urine

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