Increases in cholesterol and phospholipids occur early in the course of nephrotic syndrome and worsen with increasing severity of the disease, whereas elevations in triglycerides are mainly seen in severe disease. The aetiology of the hyperlipidaemia involves both increased lipoprotein synthesis and decreased lipoprotein catabolism. Along with the increased synthesis of albumin, which accompanies the hypoalbuminaemia, the productions of lipoproteins is also elevated. The stimulus for the increased synthesis appears to be, at least in part, the decrease in oncotic pressure rather than the hypoalbuminaemia per se. The increased cholesterol in the setting of increased LDL/HDL cholesterol ratios should put nephrotic patients at increased risk of cardiovascular disease.