The term neprhrotic syndrome defines a clinical diagnosis characterized by the precence of massive proteinuria (>40 mg/m2/h) and hypoalbuminemia (<2.5 mg/dl). Dydlipidemia is frequently associated feature and includes high levels of cholestrol, triglycerides, and lipoproteins due to enhanced hepatic synthesis. Plasma concentrations of low molecular weight apoproteins A-I and A-II are low due to increased urinary loss. The high production of atherogenic lipoproteins carries an elevated risk of cardiovascular damage in patients with long standing disease. it is also known that proteinuria is associated with renal endhotelial dysfunction, inflammation, and oxidative stress.
It is surpising that little attention has been paid to plasma fatty acid compotition in patients with nephrotic range proteinuria. Plasma free patty acids are bound to albumin, filtered through the glomeruli, and reabsorbed at the proxymal nephron by megalin mediated endocytosis. Therefore, It is reasonable to assume that if urinary losses are not compensated by increased dietary intake, an essential fatty acid (EFA) deficiency profile may develop in patients with long standing proteinuria.
A deficit of polyunsaturated fatty acid (PUFA), of both the w3 and w6 series, Was demonstrated in patients with immunoglobulin (lg) A nephropathy, but such deficit was attributed to nutritional rather than renal causes. the deficit of PUFA is of special interest because therapy of lgA nephropathy with PUFA w3, in the form of fish oil, has been recomended with the aim of decreasing proteinuria and improving glomerular filtration rate.
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