Verzola A, Perini L, Gatto S, Gilli P, Bedani P L
Divisione di Nefrologia, Azienda Ospedaliera S. Anna, Ferrara.
Recenti Prog Med. 1998 Nov;89(11):590-7.
The most widely studied hyperlipidemies in patients affected by renal insufficiency or subsequent to kidney transplant present phenotype IIa, IIb or IV. The lipidic alteration most frequently observed in chronic renal insufficiency and/or dialytic treatment is represented by hypertrigliceridemia as a result of: 1) altered VLDL metabolism; 2) reduced activity of lecithin cholesterol acyltransferase (LCAT); 3) decrease in Apo-A1 and HDL3. Furthermore, marked anomalies in lipoprotein Lp (a) have been reported in hemodialysis. In patients undergoing peritoneal dialysis, hyperlipidemia arises from both an anomalous retrograde absorption of glucose and protein dispersion. Following kidney transplant the most frequent hyperlipidemia is hypercholesterolemia, consequent to immunosuppressive treatment (mainly steroids and cyclosporin). The documented significant increase of cardiovascular risk in the presence of hyperlipidemia points to the need for a clearer etiopathogenic definition of this anomaly, as well as the necessity to find an efficacious pharmacological treatment.
在肾功能不全患者或肾移植后患者中，研究最为广泛的高脂血症表现为IIa型、IIb型或IV型。在慢性肾功能不全和/或透析治疗中最常观察到的脂质改变是高甘油三酯血症，其原因如下：1）极低密度脂蛋白（VLDL）代谢改变；2）卵磷脂胆固醇酰基转移酶（LCAT）活性降低；3）载脂蛋白A1（Apo-A1）和高密度脂蛋白3（HDL3）减少。此外，血液透析中已报告脂蛋白Lp（a）存在明显异常。在接受腹膜透析的患者中，高脂血症源于葡萄糖的异常逆向吸收和蛋白质弥散。肾移植后，最常见的高脂血症是高胆固醇血症，这是免疫抑制治疗（主要是类固醇和环孢素）的结果。有记录表明，高脂血症会显著增加心血管疾病风险，这表明需要更明确地定义这种异常的病因，同时也有必要找到有效的药物治疗方法。
