Prevalence and study of lipid abnormalities in nephrotic syndrome attending a tertiary hospital, Nepal

Sushil Baral, Binaya Kumar Baral, Karan Joshi, Swarup Shrestha, Kanak Bahadur Raut, Bharat Jha


Background: The nephrotic syndrome is a common presentation of adult or pediatric kidney diseases characterized by proteinuria, dyslipidemia, edema and hypoalbuminemia. Mainly, two types of dyslipidemia are observed: elevated serum cholesterol alone (hypercholesterolemia) and elevation of serum cholesterol along with triglyceride (combined hyperlipidemia). Therefore, majority of patients could predispose for the development of coronary artery disease and other related complications.

Methods: This was the prospective hospital-based study conducted in Tribhuvan University Teaching Hospital (TUTH), Nepal. Total sixty patients who meet the inclusive criteria were selected and enrolled from Nephrology outpatient department (OPD) and ward, attending from May 2009 till August 2010.

Results: In this study, total sixty patients were enrolled who was diagnosis as primary nephrotic syndrome that was established by clinical parameters supported by renal biopsy. Minimal change glomerulonephritis was common diagnosis by renal biopsy followed by Focal segmental glomerulosclerosis (FSGS). The total serum cholesterol, TG and HDL was normal in 25%, 15%, 83.3% whereas, it is high among 75%,85% and 1.7% of the study populations. Similarly, 24hour urinary protein was >3.5gm/day in all patients. Total serum protein and albumin was normal in 18.3% and 8.3% respectively whereas, rest of the patients had low serum protein and albumin levels. TC/HDLc ratios were and among them, 70% had moderate to high risk value. Similarly, in this study, the serum cholesterol, TG and TC/HDL level was inversely correlated with low protein and albumin.

Conclusions: Majority of patients have derangement of lipid profile among nephrotic syndrome patients, which could also predispose for the development of coronary artery disease.


Adults, Dyslipidemia, Hypoalbuminemia, Nephrotic Syndrome, Proteinuria

Full Text:



Hull RR, Goldsmith DJA. Nephrotic syndrome in adults. BMJ. 2008;336:1185-9.

Keddis MT, Karnath BM. The Nephrotic syndrome. Hosp Physician. 2007;43:25-30.

Shearer GC, Kaysen GA. Proteinuria and plasma compositional changes contribute to defective lipoprotein catabolism in the nephrotic syndrome by separate mechanisms. Am J Kidney Dis. 2001 Jan 1;37(1):S119-22.

Tarik MH, Ekram AR, Haque MA, Islam AM, Uddin MJ. Renal pathology in adult onset idiopathic nephrotic syndrome a study of 100 cases. J Teachers Association. 2007;20(2):140-3.

Majumdar A, Wheeler DC. Lipid abnormalities in renal disease. JR Soc Med. 2000;93:178-82.

Marsh JB, Drabkin DL. Hepatic secretion of lipoproteins in the rat and the effect of experimental nephrosis. J Lipid Res. 1979;25:1229-37.

Toto RD, Vega GL, Grundy SM. Mechanisms and treatment of dyslipidemia of renal diseases. Current Opinion Nephrol Hypertension. 1993 Sep;2(5):784-90.

Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003 Aug 23;362(9384):629-39.

Biswas A, Basu R. Derangement in lipid profile in nephrotic syndrome in children. Int J Res Med Sci. 2018 Mar 28;6(4):1269-72.

Chan KW, Chan DT, Cheng IK. Clinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5-year prospective review. Hong Kong Med J. 1999;5:240-4.

Korbet SM, Genchi RM, Borok RZ, Schwartz MM. The racial prevalence of glomerular lesions in nephrotic adults. Am J Kidney Dis. 1996 May 1;27(5):647-51.

Chen H, Tang Z, Zeng C, Hu W, Wang Q, Yu Y, et al. Pathological demography of native patients in a nephrology center in China. Chinese Med J. 2003 Sep;116(9):1377-81.

Yasushi Ueda. Nephrotic Syndrome in Japan. Jap J Med. 1976;15(2):103-11.

Choi IJ, Jeong HJ, Han DS, Lee JS, Choi KH, Kang SW, et al. An analysis of 4,514 cases of renal biopsy in Korea. Yonsei Med J. 2001 Apr 1;42(2):247-54.

Cameron JS. Focal segmental glomerulosclerosis in adults. Nephrol Dial Transplant. 2003 Aug;18 Suppl 6:vi45-51.

Parichatikanond P, Chawanasuntorapoj R, Shayakul C, Choensuchon B, Vasuvattakul S, Vareesangthip K, et al. An analysis of 3,555 cases of renal biopsy in Thailand. J Med Assoc Thai. 2006 Aug;89(Suppl 2):S106-11.

Tse KC, Lam MF, Yip PS, Li FK, Choy BY, Lai KN, et al. Idiopathic minimal change nephrotic syndrome in older adults: steroid responsiveness and pattern of relapses. Nephrol Dial Transplant. 2003 Jul 1;18(7):1316-20.

Francisco AT, Marcial MR, Alcantara EV, de Leon FA, Rosales LN, Mercado LB, et al. Dyslipidemias in nephrotic syndrome. Phil J Internal Med. 1997;35:99-102.

Obrenović R, Petrović D, Glišić B, Majkić-Singh N, Trbojević J, Stojimirović B. Influence of proteinuria on disorders of lipoprotein metabolism. Yugoslav Med Biochem. 2005;24(4):259-64.

De Sain-van der Velden MG, Kaysen GA, Barrett HA, Stellaard F, Gadellaa MM, Voorbij HA, et al. Increased VLDL in nephrotic patients results from a decreased catabolism while increased LDL results from increased synthesis. Kidney Int. 1998;53(4):994-1001.

Appel G. Lipid abnormalities in renal disease. Kidney Int. 1991;39(1):169-83.

Joven J, Clivillé X, Camps J, Espinel E, Simo J, Vilella E, et al. Plasma protein abnormalities in nephrotic syndrome: effect on plasma colloid osmotic pressure and viscosity. Clin Chem. 1997 Jul 1;43(7):1223-31.