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LIPID‐LOWERING IMPROVES ENDOTHELIAL FUNCTION IN NEPHROTIC RANGE PROTEINURIA
Author(s) -
Dogra G.,
Herrmann S.,
Playford D.,
Irish A.B.,
Watts G.F.
Publication year - 2000
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1046/j.1440-1797.2000.abs155.x
Subject(s) - atorvastatin , medicine , brachial artery , proteinuria , endothelial dysfunction , renal function , endocrinology , creatinine , urology , endothelium , excretion , nephrotic syndrome , cardiology , kidney , blood pressure
OBJECTIVE: To determine whether lipid‐modifying therapy with atorvastatin improves impaired endothelial function in patients with nephrotic range proteinuria (NRP). METHODS: A sequential, open‐label study of the effects of atorvastatin on dyslipidaemia and endothelial dysfunction in 9 patients with NRP. Endothelial function was assessed at baseline, after 12 weeks of atorvastatin treatment and after an 8 week wash‐out period. Brachial artery endothelial function was studied by measuring post‐ischaemic flow‐mediated dilatation (FMD) using ultrasonography. Endothelium‐ independent, glyceryl trinitrate (GTN) mediated vasodilatation was also measured. RESULTS: At baseline, median serum albumin was 31g/L (range 20‐40) and 24 hour protein excretion was 4.7g (1.0‐16.23). There was no significant change in serum creatinine and 24 hour protein excretion during the study. Total cholesterol (TC) and triglycerides (TG) were significantly lower following treatment with atorvastatin 20mg (20‐40): TC 8.1mmol/L (5.9‐14.9) vs. 5.2 (4.0‐8.6), TG 2.9mmol/L (1.3‐15.0) vs. 1.6 (1.0‐3.5), both p < 0.05. Brachial artery FMD improved significantly following atorvastatin treatment: 2.1% (‐1.2‐ 5.2%) to 4.7% (0.8‐16.3%), p < 0.05. At the end of the 8 week wash‐out, FMD had significantly deteriorated to 3.2% (‐2.8‐8.2), p < 0.05 vs. week 12 FMD, and was similar to pre‐treatment values. GTN mediated dilatation was unchanged through the study. CONCLUSION: Atorvastatin significantly reduced the hyperlipidaemia of NRP. This was associated with improved conduit artery endothelial function after 12 weeks of treatment. This is consistent with the hypothesis that dyslipoproteinaemia is the primary cause of endothelial dysfunction in NRP.