How is hyperlipidemia treated in pediatric nephrotic syndrome?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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Answer

Lipid abnormalities generally resolve when nephrotic syndrome is in remission. Dietary modification does not appear to be effective in limiting hyperlipidemia during active nephrotic syndrome. [64]

Chronic hyperlipidemia has been linked to an increased risk of atherosclerosis and coronary artery disease. [41] Chronic hyperlipidemia has also been associated with progression of renal disease. However, the small studies to date of lipid-lowering agents in pediatric INS have not shown an improvement in proteinuria or progression of renal disease. [33]

Dyslipidemias in adults with nephrotic syndrome have been successfully treated with the following:

Children with INS have been effectively treated with probucol, but this agent has been associated with a prolonged QT interval and is not available in the United States. Gemfibrozil has also been shown to be effective in childhood nephrotic syndrome in small studies. [64]

Small studies have shown that simvastatin and lovastatin are well tolerated and effective in childhood INS. Total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol were reduced by 42%, 44%, and 46%, respectively. No changes in proteinuria, hypoalbuminemia, or progression of renal disease were noted. [18, 64, 65]

In order to monitor for treatment-associated rhabdomyolysis, children treated with statins should have creatine kinase measured prior to initiating therapy and every 6-12 weeks during treatment. Patients and families should be instructed to report muscle soreness, tenderness, or pain. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels should be measured before initiating treatment and about every 3 months thereafter to monitor for liver toxicity. [64]

Long-term safety studies regarding statins in pediatrics are lacking, and the routine use of statins was not recommended by an expert panel. The only drugs recommended by the panel were bile acid sequestrants. [64]


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