Abstract
Glucocorticoid excess is known to evoke plasma lipid elevation in both men and animals, however, the effect on lipid metabolism in patients with nephrotic syndrome (NS) is still unclear. Present study deals with the effect of prednisolone, the most widely used oral glucocorticoid preparation, in two nephrotic groups of steroid resistant NS (SRNS) and steroid sensitive NS (SSNS), and changes of serum lipids, lipoproteins and apolipoproteins were investigated.
Total cholesterol (TC) was significantly increased after prednisolone treatment (80-125mg, alternate day) among the patients with SRNS whose urinary protein unchanged, while TC was remarkably decreased after the drug treatment (30-60mg, every day) in the patient with SSNS whose urinary protein rapidly disappeared. These changes well related to serum total proteins or albumin concentration. A prospective study was then carried out in 7 patients with SRNS, and a significant rise in high density lipoprotein (HDL) cholesterol and its major apolipoprotein (apo) A-I were observed during 2 months therapy by prednisolone. Apo C-II, apo C-III, apo E but apo B were significantly increased after one month of prednisolone. Triglyceride did not change. Increased HDL-C levels was associated with the appearance of smaller HDL particle and the reduction of larger HDL particle in the plasma as assessed by gradient gel electrophoresis. These data indicates that prednisolone accerelates the direct synthesis of HDL and its major protein apo A-I without affecting triglyceride or apo B levels, which suggests an antiatherogenic effect of prednisolone in SRNS.
