Nephrotic Syndrome and Statin Therapy: An Outcome Analysis

Abstract

Background and Objectives: Hypercholesterolemia in patients with nephrotic syndrome (NS) may predispose to cardiovascular events and alter kidney function. We aimed to evaluate statins efficiency in NS patients under immunosuppression using four endpoints: remission rate (RR), end-stage kidney disease (ESKD), major cardiovascular events (MACE), and thrombotic complications (VTE). Materials and Methods: We retrospectively examined the outcome at 24 months after diagnosis of 154 NS patients (age 53 (39–64) years, 64% male, estimated glomerular filtration rate (eGFR) 61.9 (45.2–81.0) mL/min). During the follow-up, the lipid profile was evaluated at 6 months and at 1 and 2 years. Results: The median cholesterol level was 319 mg/dL, and 83% of the patients received statins. Patients without statins (17%) had similar age, body mass index, comorbidities, blood lipids levels, NS severity, and kidney function. The most used statin was simvastatin (41%), followed by rosuvastatin (32%) and atorvastatin (27%). Overall, 79% of the patients reached a form of remission, 5% reached ESKD, 8% suffered MACE, and 11% had VTE. The mean time to VTE was longer in the statin group (22.6 (95%CI 21.7, 23.6) versus 20.0 (95%CI 16.5, 23.5) months, p 0.02). In multivariate analysis, statin therapy was not associated with better RR, kidney survival, or fewer MACE; however, the rate of VTE was lower in patients on statins (HR 2.83 (95%CI 1.02, 7.84)). Conclusions: Statins did not improve the remission rate and did not reduce the risk of MACE or ESKD in non-diabetic nephrotic patients. However, statins seemed to reduce the risk of VTE. Further randomized controlled studies are needed to establish statins’ role in NS management.

Subcutaneous batoclimab in generalized myasthenia gravis: Results from a Phase 2a trial with an open‐label extension

“…Consistent with those results, post hoc lipid analyses using a limited number of available samples from this study also suggested dose‐dependent increases in total cholesterol, LDL‐C, and HDL‐C. These observations are likely related to reductions in serum albumin, 13,14 and were reversible upon discontinuation of the drug. Moreover, preliminary results from a study in healthy volunteers have shown that lipid increases with batoclimab treatment may be prevented by co‐administration of atorvastatin 15…”

Pediatric nephrotic syndrome: The interplay of oxidative stress and inflammation

“…It primarily affects the pediatric population with a reported incidence of 2-7 cases per 100,000 children (1). While the cause of NS in pediatric patients is often idiopathic, inflammation and oxidative stress have been implicated in its pathogenesis and complications (1,2). Glucocorticoids are the primary treatment for idiopathic NS, leading to clinical remission in the majority of patients within 4 weeks.…”

“…Oxidative stress denotes the state of imbalance between reactive oxygen species (ROS) and the antioxidant system that eliminates them, resulting in compromised cellular signaling and cell damage (7). Oxidative stress can contribute to the development and progression of NS by damaging the glomerular filtration barrier, promoting inflammation, altering lipid metabolism, impairing endothelial function and causing cellular damage (2,8). Several studies have shown that NS patients experience high levels of oxidative stress during the acute phase of the condition, and some studies have reported that oxidative stress markers remain elevated even after steroidinduced remission of the disease (7,9,10).…”