Serum lipid and lipoprotein profiles in children with glomerular diseases at the Kenyatta National Hospital

Abstract

The fasting serum lipid and lipoprotein profiles of children

with glomerular diseases aged 20 years and below were studied over a nine months' period between June 1987 and Febraury, 1988 inclusive.

A total of 50 patients and 48 controls matched for age, sex and dry weight were recruited into the study. Serum electrolytes', creatinine, protein, albumin and blood urea and nitrogen were also studied. Renal biopsies were done where possible, to establish a histopathological diagnosis. A total of 44 renal biopsies were done. The renal tissue was diagonostic in 41 (82%) patients.

The majority of the patients with glomerular disease were ln the

5 - 9 years age range comprising 18 (36.3%) of the study patients. There was a male predominance of 2:1. More thrul 25 (50%) of the patients had pure nephrosis. Hypertension and haematuria were present in 18 (36%) and 17 (34%) of the patients respectively. The controls had the following mean serum lipids and lipoporteins:-

TC 3.7 ± 0.1 mmol/L, TG 0.6 ± 0.2 mmol/L, LDL 2.5 ± 0.9 mmol/L HDL 1.02 ± 0.1 mmol/L and VLDL 0.3 ± 0.1 mmol/L. The same mean serum lipid and lipoprotein levels in the patients were as follows:­ TC 7.8 ± 3.3 mmol/L TG 2.3 ± 0.9 mmol/L, LDL 5.T ± 3.1 mmol/L, HDL 0.75 ± 0.1 mmol/L and VLDL 1.2 + 0 .6. mmol/L.

Significant alterations (P < 0.001) in the lipid and lipoprotein profiles was found in 36/50 (72%) of the patients. These patients had elevated ie, TG, LDL and VLDL while HDL was decreased.

The patients who were being treated with corticosteroids exhibited markedly low TG and VLDL fractions. The male patients were found to have relatively higher lipid and lipoprotein fraction elevations compared to the female patients.

Focal glomerulosclerosis was the commonest histopatholigical lesion being present in 10/44 (22.7%) of all the biopsies studied. Patients with diffuse proliferative, rresangiocapillary and crescenteric histopathological lesions had the highest lipid and lipoprotein elevations.

No significant correlations were found between total serum proteinAboth the lipid and lipoprotein fractions .. Positive correlations were found between TG and BUN as wetl as between TG, VLDL, TC and serum albumin. Likewise a negative correlation between creatinine and TG. The mean serum lipid and ljpoprotein fractions observed in the study patients are lower than ,those seen in normal adults both in Kenya and in the Western world as well as those seen in Western Africa.