HYPERLIPIDEMIA, DIET AND SIMVASTATIN THERAPY IN STEROID-RESISTANT NEPHROTIC SYNDROME OF CHILDHOOD

In children with steroid-resistant nephrotic syndrome (SRNS) hyperlipi daemia may in the long term be associated with progressive renal insuf ficiency and increased risk of coronary heart disease. We have assesse d the efficacy and tolerability of diet prior to and in combination wi th a hydroxymethylglutaryl CoA reductase inhibitor, simvastatin, in se ven children with SRNS with a mean age of 8 years (range 1.8-16.3 year s). Dietary advice to maintain adequate energy and protein intakes wit h reduced saturated fat and cholesterol intake had little impact on li pid levels pre treatment (mean reduction in cholesterol 1 mmol/l, trig lyceride 1.1 mmol/l) but was maintained throughout the study duration. The mean cholesterol and triglyceride concentrations pre treatment we re 12.1+/-2 (SEM) mmol/l and 8+/-2.1 (SEM) mmol/l, respectively. On a median simvastatin dose of 10 mg/day (range 5-40 mg) there was a 41% r eduction in cholesterol to 6.6+/-0.77 (SEM) mmol/l and a 44% reduction in triglyceride to 3.9+/-1.38 (SEM) mmol/l at 6 months which was sust ained at 12 months in five patients. The drug was well tolerated with no clinical side effects being noted. Over 6 months the mean plasma al bumin concentrations increased from 18.2+/-1.26 (SEM) g/l to 23+/-2.51 (SEM) g/l, accounted for by three patients (1 complete remission, 1 p artial remission, 1 end-stage renal failure). Plasma creatinine concen trations remained stable in five patients with two having progressive chronic renal failure. Growth parameters for both weight and height we re maintained. Simvastatin has a beneficial effect on abnormal lipid l evels in SRNS but the effectiveness of long-term therapy needs to be e valuated.