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Nephrotic Dyslipidaemia Mechanism — ESENeph MCQ

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ModerateGlomerulonephritisNephrotic Dyslipidaemia MechanismESENeph

A 42-year-old woman with glomerulonephritis and heavy proteinuria (8 g/day) develops severe hyperlipidaemia (total cholesterol 14 mmol/L, triglycerides 8 mmol/L). What is the mechanism of nephrotic dyslipidaemia?

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Correct answer: B — Hepatic overproduction of lipoproteins (VLDL, LDL, Lp(a)) driven by hypoalbuminaemia – the liver upregulates protein synthesis including apolipoproteins; reduced lipoprotein lipase activity impairs triglyceride clearance

Nephrotic dyslipidaemia results from: (1) hepatic overproduction of lipoproteins – hypoalbuminaemia triggers generalised hepatic protein synthetic upregulation, including VLDL and apolipoprotein B overproduction; (2) reduced catabolism of lipoproteins due to urinary loss of lipoprotein lipase cofactors and reduced hepatic LDL receptor expression; (3) elevated Lp(a) from increased hepatic synthesis. Treatment includes statin therapy (evidence for CV benefit is extrapolated from general population data) and treating the underlying glomerular disease to achieve remission. The dyslipidaemia typically resolves with remission of nephrotic syndrome.

Reference: KDIGO 2021 – GN Guideline (Chapter 1: Complications); Kaysen 2001