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Lovastatin in glomerulonephritis patients with hyperlipidaemia and heavy proteinuria
P C Chan1, J D Robinson, W C Yeung
1Department of Medicine, University of Hong Kong, Queen Mary Hospital.
Insights
Lovastatin effectively reduced cholesterol and LDL-C in nephrotic syndrome patients. While generally well-tolerated, it did not impact proteinuria or GFR in most patients.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Nephrotic syndrome is characterized by heavy proteinuria and hyperlipidemia.
- Statins are HMG-CoA reductase inhibitors used to manage hyperlipidemia.
- The efficacy and safety of statins in nephrotic syndrome require further investigation.
Purpose of the Study:
- To evaluate the efficacy and tolerability of lovastatin in patients with unremittent nephrotic syndrome.
Main Methods:
- 14 patients with nephrotic syndrome received lovastatin for 6 months.
- Doses ranged from 20 mg/day to 80 mg/day.
- Lipid profiles, proteinuria, and GFR were monitored.
Main Results:
- Lovastatin significantly reduced serum cholesterol (31%), LDL-C (43%), and apolipoprotein B.
- Hypertriglyceridemia and rhabdomyolysis were observed in two patients.
- Proteinuria, albumin clearance, and overall GFR remained unchanged.
- A GFR increase was noted in patients with pretreatment GFR > 70 ml/min/1.73 m2.
Conclusions:
- Lovastatin is effective in managing hyperlipidemia in nephrotic syndrome.
- Close monitoring for side effects like rhabdomyolysis and hypertriglyceridemia is crucial.
- Lovastatin does not appear to affect proteinuria or GFR in this patient group.
Abstract:
Lovastatin, a 3-hydroxy-3-methylglutaryl coenzyme A inhibitor, was given to 14 patients with unremittent nephrotic syndrome (heavy proteinuria with hyperlipidaemia) for 6 months. Treatment was started at an initial dose of 20 mg/day, increasing to a maximum of 80 mg/day. Treatment was well tolerated except in two patients: one developed rhabdomyolysis and one severe hypertriglyceridaemia requiring an additional antihyperlipidaemic agent. Lovastatin was effective in reducing serum cholesterol, LDL-C and apolipoprotein B in the remaining 12 patients. Cholesterol was reduced by 31% from 8.24 +/- 0.49 mmol/l (mean +/- SEM) to 5.7 +/- 0.18 mmol/l after 6 months (P less than 0.001). LDL-C was normalized to 3.26 +/- 0.21 mmol/l from a pretreatment value of 5.76 +/- 0.48 mmol/l (P less than 0.001), a decrease of 43%. Serum apolipoprotein B was also normalized to 1.11 +/- 0.09 g/l from a basal level of 1.51 +/- 0.10 g/l (P less than 0.05). Triglyceride, HDL-C and apolipoprotein A1 concentrations were unchanged. Proteinuria as well as renal albumin clearance were unchanged. GFR by plasma radioisotope Cr-EDTA clearance for the whole group was unaltered by treatment. However, among those with relatively good pretreatment renal function (GFR greater than 70 ml/min per 1.73 m2), GFR increased at the end of 6 months' treatment (118.2 +/- 15 ml/min per 1.73 m2 versus 77.6 +/- 8.4 ml/min per 1.73 m2 in wash-out phase).(ABSTRACT TRUNCATED AT 250 WORDS)