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Fokal Segmental Glomerüloskleroz ve Membranöz Glomerülopatili Hastalarda Antiproteinürik Tedavinin Lipit Düzeylerine Etkisi

The Effect of Antiproteinuric Treatment on Lipid Levels in Patients with Focal Segmental Glomerulosclerosis and Membranous Glomerulopathy

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DOI: 
DOI 10.5262/tndt.2013.1001.10
Abstract (2. Language): 
OBJECTIVE: The primary objective of our study was to investigate effects of antiproteinuric treatment on lipid levels of patients with idiopathic focal segmental glomerulosclerosis (FSGS) or membranous glomerulonephritis (MGN). MA TERIAL and M ETHODS: The clinical and laboratory data of the patients were recorded at three-month intervals during 18 months of follow-up. Patients with non-nephrotic proteinuria without hypoalbuminemia received conservative treatment while those with more severe disease received steroid therapy as well. Lipid parameters in the two groups and the factors effective on these parameters were investigated. RESUL TS: Sixty eight patients (36 with FSGS, 32 with MG) were included. The mean age of the patients and the follow-up period were 39.6±16.6 years and 16.4±8.9months, respectively. 36 (53%) patients received steroid therapy. The percentage of patients taking antilipemic treatment was statistically significantly higher in the group taking steroid therapy. LDL cholesterol levels were higher at the beginning in patients taking steroid therapy but the difference disappeared after the ninth month. Total and LDL cholesterol levels showed a negative correlation with albumin levels and a positive correlation with proteinuria level. CONCLU SION: Treatment of hyperlipidemia in nephrotic syndrome should be directed towards increasing serum albumin levels, and therefore treatment of the glomerular disease. Antilipidemic therapies should be considered in patients who do not respond to other antiproteinuric treatment.
Abstract (Original Language): 
AMA Ç: Çalışmamızın amacı, idiopatik fokal segmental glomerüloskleroz (FSGS) ve membranöz glomerülopati (MGN) tanılı hastalarda antiproteinürik tedavinin lipit düzeylerine etkisini incelemektir. GEREÇ ve YÖN TEML ER: Hastaların 18 aylık takibi boyunca üç ay aralarla klinik ve laboratuar bulguları kaydedildi. Hipoalbüminemisi olmayan ve non-nefrotik düzeyde proteinürisi olan hastalar konservatif tedavi alırken; daha ağır proteinürisi olan hastalar aynı zamanda steroid tedavisi aldı. Her iki grupta da lipit parametreleri ve bu parametreler üzerine etkili faktörler araştırıldı. BUL GULA R: 68 hasta (36 FSGS, 32 MGN) çalışmaya alındı. Ortalama yaşları ve takip süreleri sırası ile 39,6±16,6 yıl ve 16,4±8,9 ay olarak saptandı. 36 (%53) hasta steroid tedavisi aldı. Anti-lipemik ilaç kullanan hasta oranı steroid tedavisi gören hasta grubunda daha yüksekti. Başlangıç LDL kolesterol düzeyleri steroid tedavisi alan grupta daha yüksek olsa da bu fark dokuzuncu aydan sonra kayboldu. Total ve LDL kolesterol düzeyleri albümin ile negatif, proteinüri düzeyi ile pozitif korele bulundu. SONU Ç: Nefrotik sendromda hiperlipideminin tedavisi serum albümin düzeyini yükseltmeye, dolayısıyla glomerüler hastalığın tedavisine yönelik olmalıdır. Anti-lipemik ajanlar diğer antiproteinürik tedaviye yanıt alınamayan hastalarda uygulanmalıdır.
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REFERENCES

References: 

1. Baxter JH, Goodman HC, Allen JC: Effects of infusions of serum
albumin on serum lipids and lipoproteins in nephrosis. J Clin Invest
1961; 40: 490
2. Stenvinkel P, Berglund L, Heimburger O, Petersson E, Alvestrand
A: Lipoprotein(a) in nephrotic syndrome. Kidney Int 1993; 44:
1116-1123
3. Radhakrishnan J, Appel AS, Valeri A, Appel GB: The nephrotic
syndrome, lipids, and risk factors for cardiovascular disease. Am J
Kidney Dis 1993; 22: 135-142
4. Ordonez JD, Hiatt RA, Killebrew EJ, Fireman BH: The increased
risk of coronary heart disease associated with nephrotic syndrome.
Kidney Int 1993: 4: 638-642
5. Moorhead JF, Chan MK, El-Nahas M, Varghese Z: Lipid
nephrotoxicity in chronic progressive glomerular and
tubulointerstitial disease. Lancet 1982; 2: 1309-1311
6. Ravid M, Neumann L, Lishner M: Plasma lipids and the progression
of nephropathy in diabetes mellitus type II: Effect of ACE inhibitors.
Kidney Int 1995; 47: 907
7. Keane WF, Kasiske BL, O’Donnell MP: Lipids and progressive
glomerulosclerosis: A model analogous to atherosclerosis. Am J
Nephrol 1988; 8: 261-271
8. Kasiske B, Cosio FG, Beto J, Bolton K, Chavers BM, Grimm Jr R,
Levin A, Masri B, Parekh R, Wanner C, Wheeler DC, Wilson PWF:
Clinical practice guidelines for managing dyslipidemias in kidney
transplant patients: A report from the Managing Dyslipidemias in
Chronic Kidney Disease Working Group of the National Kidney
Foundation Kidney Disease Outcomes Quality Initative. Am J
Transplant 2004; 4 Suppl 7: 13
9. Wanner C, Krane V, Metzger T, Quaschning T: Lipid changes and
statins in chronic renal insufficiency and dialysis. J Nephrol 2001;
14 (Suppl 4): 76-80
10. Wheeler DC, Bernard DB: Lipid abnormalities in the nephrotic
syndrome: Causes, consequences, and treatment. Am J Kidney Dis
1994; 23: 331-346
11. Massy ZA, Ma JZ, Louis TA, Kasiske BL: Lipid-lowering therapy
in patients with renal disease. Kidney Int 1995; 48: 188-198
12. Thomas ME, Harris KP, Ramaswamy C, Hattersley JM, Wheeler
CW, Varghese Z, Williams JD, Walls J, Moorhead JF: Simvastatin
therapy for hypercholesterolemic patients with nephrotic syndrome
or significant proteinuria. Kidney Int 1993; 44: 1124-1129
13. Demant T, Mathes C, Gutlich K, Bedynek A, Steinhauer HB,
Bosch B, Packard CJ, Warwick GL: A simultaneous study of the
metabolism of apolipoprotein B and albumin in nephrotic patients.
Kidney Int 1998; 54: 2064
14. Warwick GL, Packard CJ, Demant T, Bedford DK, Boulton-Jones
JM, Shepherd J: Metabolism of apolipoprotein B-containing
lipoptoteins in subjects with nephritic-range proteinuria. Kidney Int
1991; 40: 129
15. Kronenberg F, Lingenhel A, Lhotta K, Rantner B, Kronenberg
MF, König P, Thiery J, Koch M, von Eckardstein A, Dieplinger H:
Lipoprotein(a)- and low-density lipoprotein-derived cholesterol in
nephrotic syndrome: Impact on lipid-lowering therapy? Kidney Int
2004; 66: 348-354
16. Agarwal R: Statin induced proteinuria: Renal injury or
renoprotection? J Am Soc Nephrol 2004; 15: 2502-2503
17. Ozsoy RC, Koopman MG, Kastelein JJ, Arisz L: The acute
effect of atorvastatin on proteinuria in patients with chronic
glomerulonephritis. Clin Nephrol 2005; 63: 245-249
18. Lee TM, Lin MS, Tsai CH, Chang NC: Add-on and withdrawal
effect of pravastatin on proteinuria in hypertensive patients treated
with AT receptor blockers. Kidney Int 2005; 68: 779-787
19. Douglas K, O’Malley PG, Jackson JL: Meta-analysis: the effect of
statins on albuminuria. Ann Intern Med 2006; 145: 117-124
20. Joven J, Villabona C, Vilella E, Masana L, Albertí R, Vallés M:
Abnormalities of lipoprotein metabolism in patients with the
nephrotic syndrome. N Engl J Med 1990, 323: 579-584
21. Baxter JH, Goodman HC, Allen JC: Effects of infusions of serum
albumin on serum lipids and lipoproteins in nephrosis. J Clin Invest
1961; 40: 490-498

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