Table 3.
Clinical trials and studies of dyslipidaemia treatments in patients with nephrotic syndrome
| Treatment | Action | Outcomes | Limitations | Refs or trials |
|---|---|---|---|---|
| Conservative lifestyle changes (diet, weight, exercise) | • ↓ Cholesterol • ↓ Apolipoproteins (small reduction) • ↓ Triglycerides |
• ↓ Hyperlipidaemia • ↓ Proteinuria |
Implementation and patient compliance | 121–123 |
| Statins | • ↓ HMG CoA | • ↓ LDL • ↓ Cholesterol • ↓ Triglycerides • ↑ HDL • Few adverse effects • Improved cardiovascular outcome in CKD |
Limited number of studies | 125–131,139*,140*, NCT00004466* (REF. 157), NCT01845428 (REF. 158) |
| Bile acid sequestrants | • ↓ Enterohepatic bile acid circulation | • ↓ LDL | • Gastrointestinal adverse effects • Less effective than statins |
133 |
| Fibrates | • ↑ Lipoprotein lipase activity | • ↓ Triglycerides • ↓ LDL • ↓ Cholesterol |
Meta-analysis found a lack of support for fibrate efficacy | 112,134,135 |
| LDL-apheresis | • ↓ LDL • ↓ Cholesterol • ↓ Triglycerides • ↑ Response to immunosuppressants |
• Complete or partial remission of nephrotic syndrome • Few adverse effects |
Requires central venous access | 141*,142–144, NCT02235857* (REF. 154) |
| • Anti PCSK9 antibodies • PCSK9 RNA interference |
• Inactivation of PCSK9 • Degradation of PCSK9 mRNA • ↑ Hepatic LDLR |
• ↓ LDL | Very expensive | 44‡, NCT03004001 (REF. 149), NCT02314442‡ (REF. 146) |
*
Studies or trials with paediatric patients.
‡
Not in nephrotic syndrome setting. CKD, chronic kidney disease; HDL, high density lipoprotein; HMG CoA, 3 hydroxy 3 methyl glutaryl coenzyme A; LDL, low density lipoprotein; LDLR, LDL receptor; PCSK9, proprotein convertase subtilisin/kexin type 9.