Neuromuscular toxicity in nephrotic patients treated with fluvastatin

Nephrotic dyslipidemia is a risk factor for the development of systemic atherosclerosis, and may aggravate glomerulosclerosis and enhance progression of glomerular disease. The greatest and most consistent reductions in LDL-cholesterol are achieved with HMG-CoA reductase inhibitors but their efficacy and safety in long-term therapy need to be evaluated. In this study, we gave fluvastatin to 21 nephrotic patients and followed then up clinically, neurophysiologically and by laboratory tests. There was an improvement in the lipogram, with reductions of triglycerides (TG) (33%) and LDL (35%) at three months. There was no clinical manifestation of myopathy and CPK was normal. Electromyographic data showed significant decreases in the amplitude and duration of motor unit action potentials in the proximal muscles with statin therapy, but these changes did not amount to classic myopathy. We conclude that fluvastatin is a safe drug for long-term use in dyslipidemic nephrotic patients. However, we suggest further studies to verify whether the early electromyography (EMG) changes observed in this study may progress or not on its longer term use.