DYSLIPIDEMIA IN PATIENTS WITH RENAL DISEASES

Patients with renal diseases commonly exhibit lipid abnormalities whic h could contribute to the high incidence of coronary heart disease obs erved in this population. Moreover, it has recently been suggested tha t altered lipoprotein metabolism in various renal diseases may play an important role in the progression of renal failure. Patients with nep hrotic syndrome (NS) develop increased concentrations of total cholest erol and low-density lipoprotein cholesterol (LDL-C), of lipoprotein ( alpha) as well as of triglycerides due to increased hepatic production of triglyceride-rich lipoproteins and to defective lipoprotein catabo lism. A low fat diet is the cornerstone of treatment in nephrotic dysl ipidaemia. Hypolipidaemic drugs should also be used in patients not re sponsive to diet beta-hydroxy-beta-methylglutaryl-coenzyme A reductase inhibitors (statins) are regarded as the drugs of choice in treating lipoprotein abnormalities in NS patients. The main lipid abnormalities in patients with end-stage renal disease ore hypertriglyceridaemia an d reduced high-density lipoprotein cholesterol levels. However, the ch aracteristic features of uraemic dyslipidaemia are more closely reflec ted in the apolipoprotein rather than in the lipid profile impaired ca tabolism of triglyceride-rich apolipoprotein B-containing lipoproteins of hepatic and intestinal origin is the main pathophysiological mecha nism of dyslipidaemia in chronic renal failure. Moreover, increased tr iglyceride and lipoprotein synthesis could also contribute to the abno rmal lipid profile observed in this population. Dietary intervention i s of particular value in the treatment of uraemic dyslipidaemia, where as the evaluation of drug treatment in such cases is limited. Finally, lipid disturbances occur in the majority of renal transplant recipien ts (RTR). These subjects commonly exhibit increased total cholesterol and LDL-C levels as well as triglycerides. Among many clinical factors influencing lipid metabolism in RTR, the involvement of immunosuppres sive drugs, such as corticosteroids and cyclosporin, is of paramount i mportance. A hypolipidaemic diet is the cornerstone of treatment while low doses of statins have been found to be safe and effective in RTR.