A 55-year-old man with type 2 diabetes and chronic kidney disease (GFR 35 mL/min/1.73m²) presents with nephrotic syndrome and bilateral lower extremity edema. Vital signs: BP 148/92 mmHg, HR 88/min, RR 16/min, temp 37.2°C. Serum albumin is 2.1 g/dL with urine protein 8.5 g/day. Laboratory studies show total cholesterol 420 mg/dL, triglycerides 650 mg/dL, and HDL 22 mg/dL. Chest examination reveals clear lung fields. Which of the following best explains his severe hyperlipidemia?
- A)Chronic kidney disease directly decreases hepatic cholesterol synthesis
- B)Primary apolipoprotein C-II loss through proteinuria
- C)Glomerular filtration of lipoproteins leading to selective renal clearance
- D)Diabetes-induced inhibition of lipoprotein lipase by hyperglycemia alone
- E)Increased hepatic VLDL synthesis combined with impaired triglyceride clearanceGABARITO
Explicação
Nephrotic syndrome causes severe dyslipidemia through two mechanisms: (1) hepatic upregulation of apoB and VLDL production due to low albumin and compensatory protein synthesis, and (2) impaired lipoprotein lipase activity from loss of apoC-II in urine and ure... Ver explicação completa e trilha adaptativa →