Simvastatin therapy and effect on hiperlipidemia and vascular status in nephrotic children with sustained dyslipidemia

• Published in: Polski merkuriusz lekarski Vol. 26; no. 153; p. 198
• Main Authors: Ksiazek, Joanna, Niemirska, Anna, Lipka, Maria, Wierzbicka, Aldona, Syczewska, Małgorzata, Grenda, Ryszard
• Format: Journal Article
• Language: Polish
• Published: Poland 01.03.2009
• Subjects: Adolescent; Carotid Arteries - diagnostic imaging; Child; Female; Femoral Artery - diagnostic imaging; Humans; Hyperlipidemias - complications; Hyperlipidemias - diagnostic imaging; Hyperlipidemias - drug therapy; Hypolipidemic Agents - therapeutic use; Male; Nephrosis - complications; Simvastatin - therapeutic use; Treatment Outcome; Ultrasonography
• ISSN: 1426-9686

Dyslipidemia is common in nephrotic children and persistent lipid abnormalities are risk factor of late vascular complications. The aim of the study was evaluation of efficacy and safety of 12-months simvastatin therapy in nephrotic children with lipid profile abnormalities present despite clinical remission lasting for at least 8 weeks, including ultrasonographic assessment of carotid and femoral arteries. Overall 52 children (40 steroid-dependent and 12 steroid-resistant) were initially introduced to the study and 29 of them were treated with simvastatin. Normalisation of lipid profile was achieved in 19/29 (65.5%) and improvement in 9/29 (31%). Significant reduction in total cholesterol (p < 0.00001), LDL-C (p < 0.000003), VLDL- (p < 0.0123), oxy-LDL-C fractions (p < 0.0002) and triglycerides (TG) (p < 0.0005) serum concentration was achieved in non-proteinuric patients. Analysis of the intima-media thickness (IMT) of the common carotid (c) and superficial femoral (f) arteries values revealed positive correlation between baseline cIMT and VLDL-C (p = 0.038) and TG concentration (p = 0.008), as well as positive correlation between fIMT and baseline creatinine (p = 0.04) and LDL-C serum concentration (p = 0.032) after simvastatine treatment. Number of children with significant vessels pathology (Z-score > 2.0) was small. Increased cIMT was seen at baseline in 4 patients and in 5 after simvastatin treatment, however average and Z-score values in children under simvastatin treatment have decreased. Increased fIMT values were seen at baseline in 2 and in one case after simvastatin treatment. Tolerance of simvastation was very good in all cases but one. Simvastatin therapy was effective and safe in nephrotic non-proteinuric children with abnormal lipid profile. Fair estimation of impact of the 12-months simvastatin therapy on vascular status was not available due to limited number of children with significantly increased IMT at baseline.