The Influence of High and Low Fat Diets and Thyroid Substance on Plasma Lipids of Nephrotic Patients.

Lactescence of the serum of patients suffering from nephritis with dropsy was observed by Bright and his associate Mr. Bostock (1827 (1)). Christison (1839 (2)) however, probably first recognized that this was fat not unlike that in tissue cells. Epstein (3), in particular, recognized the importance of hypercholesterolemia as a sign in nephrosis. The later literature concerning nephritic lipemia has been reviewed by Page, Kirk, and Van Slyke (4) who have found that lipemia is the rule, not only in nephrosis, but also in the intermediate chronic stage of hematuric nephritis, and that the different lipid fractions, viz., free and esterified cholesterol, phosphatides, and neutral fats, all tend to increase in similar proportions. In the terminal stage, on the contrary, the lipids were found usually within normal, and sometimes within low normal, ranges, indicating that the lipemic tendency decreases in the final stage of the disease. In diabetes, statistics have been published (White (5) ) indicating that hypercholesterolemia favors the development of arteriosclerosis. Whether nephritic lipemia has a similar influence is unknown, but the possibility makes it appear desirable to ascertain conditions for control of the plasma lipid content in nephritis. The present paper reports work in which two procedures for this purpose have been tried: (1) Extreme variation of the fat: carbohydrate ratio in the diet and (2) thyroid administration sufficiently intense to cause marked rise in the basal metabolic rate. Feeding of thyroid substance has also been employed as a therapeutic measure in nephrosis (Dieballa and Illyes (6), Percy (7, 8), Epstein (9), and Liu (10)). Epstein recommended it chiefly as a means of correcting the lowered basal metabolism found in these patients. Epstein and Lande (11) believed that it also might aid in reducing the hyperlipemia, since Luden (12) had shown that cholesterol in the blood of patients with myxedema was higlh, and that feeding thyroid reduced it at a rate parallel to the rise in basal metabolism. They found, too, that cholesterol was low in the blood of patients with hyperthyroidism (confirmed by others ( 13 to 25) ). There was, therefore, reason to suspect that if thyroid raised the lowered basal metabolism, the hypercholesterolemia might be reduced. For these reasons study of the effect of thyroid on the hyperlipemia of nephrosis and chronic nephritis has seemed to us important.