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We characterized the lipid-lipoprotein abnormalities encountered in a series of 45 nonnephrotic uremic children with various degrees of chronic renal insufficiency. A mild hypertriglyceridemia associated with decreased serum high-density lipoprotein cholesterol levels was confirmed. The correlation between high-density lipoprotein cholesterol and creatinine clearance showed a power behavior with a marked decrease in high-density lipoprotein cholesterol below a creatinine clearance value of 40 ml/min/1.73 m2. A number of uremic children accumulate an abnormal population of very low-density lipoprotein particles in their plasma. On agarose gel electrophoresis these particles migrate as a slow moving pre-beta band and are clearly distinguished from the regular fast moving pre-beta very low-density lipoprotein band. This electrophoretic phenomenon has been called double pre-beta lipoproteinemia. The prevalence of double pre-beta lipoproteinemia increased significantly with the degree of impairment of renal function, reaching highest figures in patients on hemodialysis. Accordingly, the very low-density lipoprotein cholesterol/triglyceride ratio also was significantly increased. The double pre-beta lipoproteinemia phenomenon was not detected in any of the control, nonuremic subjects. The clinical importance of double pre-beta lipoproteinemia in uremic plasma is related to its possible atherogenic role.

The mechanism responsible for the sopontaneous diuresis that occurs prior to the recovery fron RDS is unknown. We studied the possibility for AVP-mediated diuresis in 10 consecutive preiuture infants requiring ventilation for RDS (Mean ± DS, BW 1885 ± 827; GA 32 ± 2 wk; Apgar scores 5 ± 1 and 6 ± 2 at 1′ and 5′). No alteration was made in either the administration of fluid or medications ordered by the infant's phisician. During the first five days of life, the changes of AVP were serially determined by RIA net hod (Buhlman Lab., Basel) and related to the variations in creatinine clearance (C cr), oemolality, output/ intake (O/I), body weight and pulmonary function. Even if our study concerns infants uith different RDS severity, a temporal relationship was found between diuresis, loss of weight and the improvement of pulmonary functions, without significant change in creatinine clearance. Throughout all three study periods, osmolality renamed unchanged and the urine produced was hypotonic compared Hith plasma. A decrease in the high AVP concentration is an unlikely explanation for the excretion of a dilute urine described in the present study.