Hypertension and nephrology

[Similarities and differences in the renal effects of statins]

ÁBRAHÁM György

DECEMBER 20, 2011

Hypertension and nephrology - 2011;15(05)

[By efficiently reducing serum cholesterol level, statins significantly decrease both cardiovascular morbidity and mortality. Decreasing LDL-cholesterol level by 1% reduces coronary mortality risk by 1%, whereas increasing HDL-cholesterol level by 1% reduces the risk by 3%. At the same time, renal failure significantly increases cardiovascular events and/or mortality compared with the population mean. It is an exciting question whether statins are able to prevent and decelerate the deterioration of kidney function deterioration, preserve GFR and decrease albuminuria. Depending on the strength of their effect, statins have different cholesterollowering capacity (rosuvastatin and atorvastatin are especially effective). An important question is whether these differences can be detected in the renal function as well. The results of experimental data and major clinical trials (e.g. AURORA, PLANET I-II, SHARP) are often controversial. Nevertheless, statin therapy has advantages for patients with kidney diseases, although to a lesser extent than it has in the normal population.]

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[Overweight [body mass index (BMI) = 25-30 kg/m2] and obesity (BMI ≥30 kg/m2) are epidemic in both developed and developing countries. Obesity has been recognized as risk factor for the development and progression of chronic kidney disease and is associated with increased cardiovascular risk and poor survival. Almost 2/3 of maintenance hemodialysis patients die within five years of commencing dialysis treatment. Although patients on the waitlist having less severe comorbidities than their non-listed counterparts, the death rate remains high while it can take years for an organ donation. In patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis an “obesity paradox” has been consistently reported, i.e., a high BMI is incrementally associated with better survival. Overweight and obesity are highly prevalent in patients at the time of kidney transplantation. Indeed, most transplant centers in US may suspend wait-listing of obese patients with a BMI above 30 or 35 kg/m2 and refer them for weight reduction procedures such as bariatric surgery as a contingency for the transplant surgery. The effect of pre- and post-transplant obesity in kidney transplanted patients on long-term graft and patient survival has not been well established. We have reviewed and summarized salient recent data pertaining to body composition and clinical outcomes about the association of survival and body composition in transplant-waitlisted dialysis patients and kidney transplanted recipients. ]

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[Background: Percutaneous renal biopsy is an essential tool in diagnosis and prognosis of renal diseases. It is well-known that this method has potential complications. The connection between complication occurrence related to renal biopsies and histological diagnoses of the biopsy specimen was analyzed in the present study. We also analyzed the distribution of diagnoses in our population. Methods: In this retrospective survey, 353 patients undergoing renal biopsy was studied. Biopsies were performed after marking the site of puncture with ultrasound imaging. Influence of diagnoses and clinical parameters on complications was evaluated. Results: We found a complication rate of 44.5%. In patients with diabetic nephropathy (likelihood ratio (LR) 0.44) or acute tubular necrosis (LR 0.38) a significantly lower rate of complications was found, while patients with thin basement membrane syndrome had more than 6-fold higher risk for evolvement of intrarenal haemorrhage. Patients with acute interstitial nephritis (LR 3.18) or vasculitis (LR 2.88) have a more than 2-fold risk for arteriovenous shunts while in patients with severe arteriosclerosis the occurrence of this complication was lower (LR 0.46). In rapidly progressive glomerulonephritis, arteriovenous shunts evolved also in a significantly higher rate. Conclusion: Patients with vasculitis, rapidly progressive glomerulonephritis, thin basement membrane syndrome or acute interstitial nephritis should be monitored more carefully after renal biopsy due to the significantly higher risk for complications. ]

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[By efficiently reducing serum cholesterol level, statins significantly decrease both cardiovascular morbidity and mortality. Decreasing LDL-cholesterol level by 1% reduces coronary mortality risk by 1%, whereas increasing HDL-cholesterol level by 1% reduces the risk by 3%. At the same time, renal failure significantly increases cardiovascular events and/or mortality compared with the population mean. It is an exciting question whether statins are able to prevent and decelerate the deterioration of kidney function deterioration, preserve GFR and decrease albuminuria. Depending on the strength of their effect, statins have different cholesterol-lowering capacity (rosuvastatin and atorvastatin are especially effective). An important question is whether these differences can be detected in the renal function as well. The results of experimental data and major clinical trials (e.g. AURORA, PLANET I-II, SHARP) are often controversial. Nevertheless, statin therapy has advantages for patients with kidney diseases, although to a lesser extent than it has in the normal population.]

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