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Abstract
Increased serum concentrations of total cholesterol and low-density lipoprotein (LDL) cholesterol have been the most frequently reported abnormalities in patients with the nephrotic syndrome.1 2 3 Alterations in the composition of LDL particles are also present, as well as an increase in apoprotein B. In addition, many investigators have found increases in triglycerides and very-low-density lipoproteins (VLDL), especially in patients with massive proteinuria. [...]the HDL subtypes are abnormally distributed.3 Specifically, the level of HDL2 is markedly reduced. Since HDL2 is thought to protect against atherosclerosis, the combination of reduced HDL2 and increased LDL and VLDL cholesterol levels poses a potential risk for atherosclerosis. Dietary measures to reduce serum lipid concentrations are often unsuccessful in patients with the nephrotic syndrome, whereas newer antilipemic agents may be effective.4, 7 8 9 At present, it seems reasonable to extend the treatment guidelines adopted by the National Cholesterol Education Program to patients with unremitting nephrotic syndrome.10 However, a better understanding of the adverse effects of hyperlipidemia in such patients may ultimately justify even more aggressive treatment. 1.