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The nephrotic syndrome, lipids, and risk factors for cardiovascular disease
J Radhakrishnan1, A S Appel, A Valeri
1Department of Medicine, Columbia Presbyterian Medical Center, New York, NY.
Insights
Patients with nephrotic syndrome have significant cardiovascular disease risk factors, including hyperlipidemia. Higher initial cholesterol levels were paradoxically associated with slower progression to renal failure in this cohort.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Hyperlipidemia is a known complication of nephrotic syndrome.
- Data on cardiovascular disease risk factors and their impact on renal disease progression in nephrotic syndrome patients are limited.
- Idiopathic nephrotic syndrome presents unique challenges in managing comorbid conditions.
Purpose of the Study:
- To evaluate the prevalence of cardiovascular disease risk factors in patients with idiopathic nephrotic syndrome.
- To investigate the association between hyperlipidemia and the progression of renal disease in this population.
- To identify key risk factors for atherosclerotic heart disease in patients with nephrotic syndrome.
Main Methods:
- Retrospective evaluation of 100 patients with idiopathic nephrotic syndrome (focal segmental glomerulosclerosis or membranous nephropathy).
- Assessment of cardiovascular risk factors including sex, hyperlipidemia, hypertension, smoking, and left ventricular hypertrophy.
- Comparison of risk factors between patients who progressed to renal failure and those who did not.
Main Results:
- Nearly all patients (99%) had at least one cardiovascular risk factor; 68% had two, and 26% had three.
- Hypertension (53%) and hyperlipidemia (total cholesterol >200 mg/dL in 87%) were highly prevalent.
- Patients who progressed to renal failure had lower initial mean serum cholesterol levels (292 mg/dL) compared to those who did not (388 mg/dL).
Conclusions:
- Patients with idiopathic nephrotic syndrome exhibit a high burden of cardiovascular disease risk factors.
- The relationship between hyperlipidemia and renal disease progression in nephrotic syndrome is complex and warrants further investigation.
- Lower initial cholesterol may be associated with more rapid renal disease progression in this specific patient group.
Abstract:
The hyperlipidemia associated with the nephrotic syndrome is well characterized. There is, however, a paucity of data in humans on the risk factors for atherosclerotic heart disease and the role of hyperlipidemia on the risk of progression of renal disease in this population. In our study, we retrospectively evaluated a large uniform population of patients (mean creatinine, 1.78 mg/dL; mean 24-hour proteinuria, 7.1 g) with idiopathic nephrotic syndrome for the presence of risk factors for coronary artery disease. One hundred patients with either focal segmental glomerulosclerosis (n = 56) or membranous nephropathy (n = 44) were assessed for the following cardiovascular risk factors: male sex or postmenopausal female, hyperlipidemia, hypertension, smoking history, and left ventricular hypertrophy. Sixty-six percent of the patients were either male or postmenopausal females; 35% were smokers. Hypertension and left ventricular hypertrophy were present in 53% and 13% of patients, respectively. Eighty-seven percent, 53%, and 25% of patients had a total cholesterol of more than 200 mg/dL, more than 300 mg/dL, and more than 400 mg/dL, respectively. Low-density lipoprotein cholesterol was greater than 130 mg/dL and greater than 160 mg/dL in 77.2% and 64.9% of patients, respectively. Virtually all patients (99%) had at least one risk factor for cardiovascular disease; over two thirds (68%) had two risk factors and over one quarter (26%) had three risk factors. In comparing the group that progressed to renal failure with the groups that did not, the initial mean serum cholesterol was lower in the group that progressed (292 mg/dL v 388 mg/dL, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)