Effect of hypoalbuminemia on the increased serum cholesteryl ester transfer protein concentration in children with idiopathic nephrotic syndrome

Objectives: To examine the alteration of cholesteryl ester transfer protein (CETP) mass with the regression of albumin level in childhood nephrotic syndrome (NS) in order to clarify the effect of albumin on CETP in NS. Design and methods: Serum concentrations of CETP, kidney parameters and lipid traits were determined in 110 children with idiopathic NS and 150 control subjects. Of the NS patients, 69 children with an active phase formed group 1, and 41 in remission formed group 2. Results: Group 1 presented severe hypoalbuminemia and hyperlipidemia, while group 2 exhibited marked recovery in both serum albumin level and lipid/lipoprotein profile. CETP concentration was significantly higher in group 1 (7.36 ± 2.43 mg/L, compared with controls 3.38 ± 1.83 mg/L, P < 0.0001), and declined to within normal range in group 2 (2.91 ± 1.77 mg/L). CETP concentration had a strong inverse correlation with serum albumin level (r = − 0.688, P < 0.0001) in NS patients. Furthermore, when multiple linear regression analysis was performed, in which albumin, proteinuria, lipid traits, and prednisone dose were treated as independent variables, albumin was the only variable showing a significant correlation with CETP in the NS patients (R2 = 0.587, β = − 0.475, P < 0.0001). Conclusions: The results demonstrate that the decreased serum albumin level might be a main determinant of the increased CETP concentration in pediatric NS.