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Fluvastatin Improves Hyperlipidaemia in Nephrotic Syndrome: Presented at WCN

By Paula Moyer

BERLIN, GERMANY -- June 11, 2003 -- Patients with nephrotic syndrome have lower cholesterol levels after 3 months of treatment with fluvastatin (Lescol), according to findings presented here June 9^th at the World Congress of Nephrology.

"This finding is good news because we need to reduce hyperlipidaemia in nephrotic syndrome patients who are immunosuppressed," said Mila Ljubomirova, MD, a senior assistant nephrologist at University Hospital Alexandrovska, in Sofia, Bulgaria. "These patients are at risk of cardiovascular disease. Therefore, we need to treat them with a drug like fluvastatin."

In patients with nephrotic syndrome, hyperlipidaemia results from increased synthesis and decreased catabolism of lipoproteins. Patients typically have high levels of total cholesterol, triglycerides, low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL), although the high-density lipoproteins (HDL) may be normal.

Because of the general efficacy of HMG-CoA reductase inhibitors on hyperlipidaemia and some demonstrated potential in reducing proteinuria, Dr. Ljubomirova and her co-investigators sought to determine the effect of fluvastatin in patients with nephrotic syndrome.

They followed 7 women and 12 men, whose average age was 39 years and who had severe nephrotic syndrome, as defined by a glomerular filtration rate (GRF) of over 90 mL/min, as well as severe hyperlipidaemia, consisting of a total cholesterol level exceeding 8.5 mmol/L. Nine patients had membranous glomerulonephritis, 4 had focal segmental glomerulosclerosis, 3 had mesangiocapillary glomerulonephritis, and 3 had lupus nephritis.

All patients were treated either with corticosteroids alone or in combination with cytotoxic drugs, depending on the severity of their nephrotic syndrome. The investigators used the patients' 4-hour creatinine clearance to estimate the GFR.

Patients received 40 mg daily of fluvastatin for 3 months, after which Dr. Ljubomirova and her investigative team compared patients' total cholesterol, triglycerides, LDL, and HDL to baseline levels. They also examined patients' 24-hour proteinuria at baseline and after 3 months.

Patients' total cholesterol averaged 9.33 mmol/L at baseline and 5.91 mmol/L at the study's end, a significant decrease, Dr. Ljubomirova said (P<0.001). Triglyceride levels were also significantly reduced, from an average of 5.92 mmol/L at baseline to 2.74 mmol/L after treatment (P<0.01). LDL averaged 6.35 mmol/L at baseline and 3.57 mmol/L afterward (P<0.001). HDL levels were also lowered, but remained normal in all patients (P=0.01). However, no significant decrease in proteinuria was observed, she said.

"We saw a significant reduction of hyperlipidaemia in these patients, even though the nephrotic proteinuria remained," Dr. Ljubomirova said.

She added that she and her colleagues would like to see a long-term study that assesses the effect of statins on proteinuria with carefully selected patients who are not taking immunosuppressive therapy.


[Study title: Effects Of 3 Months Fluvastatin Treatment On Lipid Metabolism And Proteinuria In Patients With Nephrotic Syndrome. Abstract M197]

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