Dyslipidaemia in nephrotic syndrome: mechanisms and treatment

Abstract

Prolonged hyperlipidaemia in nephrotic syndrome is a major risk factor for multiple disease complications, including accelerated atherosclerosis, myocardial infarction, stroke, chronic kidney disease and thrombosis Direct lipid-induced cellular injury to podocytes, mesangial cells and, potentially, renal tubular cells as a result of dyslipidaemia increasingly seems to have a role in the pathogenesis of nephrotic syndrome Given the available evidence, we suggest that statins should be the first-line treatment for prolonged hyperlipidaemia in patients with nephrotic syndrome, given their efficacy in the treatment of other diseases and the fact that they are well tolerated Alternative, less supported treatments include LDL apheresis, cholesterol absorption inhibitors, nicotinic acid and bile acid sequestrants; targeting proprotein convertase subtilisin/kexin type 9 is another potential treatment for hyperlipidaemia in patients with nephrotic syndrome Treatment recommendations in children are limited by a lack of data for both the efficacy and the risk of pharmacological interventions