Description, Causes and Risk Factors:
Presence of lipids in the urine.
Human urine usually contains only very small amounts of lipids. However, under certain nephrotic syndromes the urinary excretion of cholesterol, cholesterol esters, triglycerides, free fatty acids and phospholipids is considerably increased. Many of these lipids originate from the plasma. In some diseases urinary excretion of specific lipids is increased. Patients with mitochondrial encephalomyopathy, for example, excrete PE (phosphatidylethanolamine), PS (phosphatidylserine) and CL (cardiolipin) derived from mitochondria and sulfatides specific to renal epithelial cells.
Increased lipuria is caused also by intake of a variety of drugs and some common chemicals. Aminoglycoside antibiotics like gentamicin injure the proximal tubular epithelial cells inducing myeloid bodies in their lysosomes. These bodies are later extruded out of the cells and cause an increase in urinary levels of phospholipids such as PE, PC, PS and PI. Nephrotoxins such as mercuric chloride or ethylene glycol induce shedding of the microvillous brush border of the renal epithelium reflected in increased urinary excretion of phospholipids such as sphingomyelin. Thus, phospholipiduria is often an indication of membranuria.
Lipuria is caused by different disorders that damage the kidneys. This damage leads to the release of too much lipids in the urine. The most common cause in children is minimal change disease. Membranous glomerulonephritis is the most common cause in adults.
This condition can also occur from:
Diseases such as diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis.
Infections (such as strep throat, hepatitis, or mononucleosis).
Use of certain drugs.
Lipuria has also been reported as a sign following fat embolism.
When lipuria occurs, these cells contain endogenous fats. When filled with numerous fat droplets, such cells are called oval fat bodies. Oval fat bodies exhibit a "Maltese cross" configuration under polarized light microscopy.
Lipuria is most frequently observed in nephrotic syndrome where it is passed as lipoproteins along with other proteins.
Swelling (edema) is the most common symptom. It may occur:
In the arms and legs, especially in the feet and ankles.
In the belly area (swollen abdomen).
In the face and around the eyes (facial swelling).
Other symptoms include:
Weight gain (unintentional) from fluid retention.
Foamy appearance of the urine.
The gold standard in diagnosis of lipuria is 24 hour urine protein measurement. Aiding in diagnosis are blood tests and sometimes imaging of the kidneys (for structure and presence of two kidneys), and/or a biopsy of the kidneys.
The following are baseline, essential investigations:
Urine sample shows proteinuria (>3.5 g per 1.73 m2 per 24 hours). It is also examined for urinary casts, which are more a feature of active nephritis.
Comprehensive metabolic panel (CMP) shows hypoalbuminemia: albumin level ?2.5 g/dL (normal=3.5-5 g/dL).
High levels of cholesterol (hypercholesterolemia), specifically elevated LDL, usually with concomitantly elevated VLDL is typical.
Electrolytes, urea and creatinine (EUCs): to evaluate renal function.
A 24 hour bedside urinary total protein estimation.
Further investigations are indicated if the cause is not clear:
Auto-immune markers (ANA, ASOT, C3, cryoglobulins, serum electrophoresis).
Ultrasound of the whole abdomen.
Biopsy of kidney.
The goals of treatment are to relieve symptoms, prevent complications, and delay kidney damage. To control lipuria, you must treat the disorder that is causing it. You may need treatment for life.
Treat high cholesterol to reduce the risk of heart and blood vessel problems. A low-fat, low-cholesterol diet is usually not very helpful for people with nephrotic syndrome. Medications to reduce cholesterol and triglycerides (usually statins) may be needed.
A low-salt diet may help with swelling in the hands and legs. Water pills (diuretics) may also help with this problem.
Blood thinners may be needed to treat or prevent blood clots.
Keep blood pressure at or below 130/80 mmHg to delay kidney damage.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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