Patients with hemorrhagic fever with renal syndrome (HFRS) often exhibit altered serum lipid and lipoprotein profile during the oliguric phase of the disease. Serum lipid and lipoprotein profiles were assessed during the oliguric and recovery phases in six male patients with HFRS. In the oliguric phase of HFRS, the apolipoprotein (apo) C-III content in high-density lipoproteins (HDL) was elevated, whereas the apoA-I content was lowered. The level of expression and activity of antioxidant enzymes were severely reduced during the oliguric phase, while the cholesteryl ester transfer protein activity and protein level were unchanged between the phases. In the oliguric phase, electromobility of HDL2 and HDL3 was faster than in the recovery phase. Low-density lipoprotein (LDL) particle size was smaller and the distribution was less homogeneous. Patients with HFRS in the oliguric phase had severely modified lipoproteins in composition and metabolism.