Lipid abnormalities, renal failure, and parathyroid hormone.
A substantial number of patients with chronic renal failure display type IV lipoproteinemia. They have elevated serum levels of very-low-density, intermediate-density, and low-density lipoprotein. Serum cholesterol levels are usually normal and those of high-density lipoprotein are low. It is generally accepted that hypertriglyceridemia is due to decreased removal from the blood secondary to reduced activity of lipoprotein lipase and hepatic lipase. Secondary hyperparathyroidism and elevated blood levels of parathyroid hormone (PTH) may play an important role in the pathogenesis of the triglyceridemia of chronic renal failure. Indeed, parathyroidectomized-normocalcemic dogs with chronic renal failure have normal serum levels of triglyceride, normal fat tolerance, and normal post-heparin lipolytic activity. Available data indicate that the abnormalities in carbohydrate and lipid metabolism in chronic renal failure are linked. Excess PTH suppresses insulin release from pancreatic islets, and the insulin deficiency results in carbohydrate intolerance. Insulin deficiency also causes decreased synthesis of lipoprotein lipase and hence abnormal lipid metabolism. Thus, the hyperparathyroidism of chronic renal failure may play a paramount role in the genesis of the abnormal metabolism of both carbohydrates and lipids.
Massry
S G
SG
Department of Medicine, University of Southern California, School of Medicine, Los Angeles 90033.
Akmal
M
M
D000818:Animals; D006949:Hyperlipidemias / Q000097:blood / Q000503:physiopathology*; D006961:Hyperparathyroidism / Q000097:blood / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology*; D008074:Lipoproteins / Q000097:blood / Q000502:physiology; D010281:Parathyroid Hormone / Q000097:blood / Q000502:physiology
D008074:Lipoproteins; D010281:Parathyroid Hormone