LONG-TERM SINGLE-BLIND CLINICAL-TRIAL OF PRAVASTATIN IN MEMBRANOUS NEPHROPATHY

Hyperlipidemia, particularly hypercholesterolemia, commonly complicate s nephrotic syndrome (NS) and accounts for the high prevalence of card iovascular disease (CVD) among these patients. According to the lipid nephrotoxicity hypothesis, severe hyperlipidemia, by causing lipoprote in deposition within the glomerular tuft, in the presence of a pre-exi sting renal injury, may lead to a worsening of renal function with pro gression of renal disease. Despite several experimental models support ing this pathogenic mechanism, no data have yet been provided in human pathology. NS secondary to idiopathic membranous nephropathy (IMN) is one of the most frequent clinical pictures encountered in renal patho logy and hence offers an ideal model for studying the relationships be tween lipid metabolism and renal disease. To date treatment of IMN rem ains largely controversial and many therapeutic approaches have been p roposed, both symptomatic and using immunosuppressive agents. Statins have been successfully employed in man for the treatment of primary hy percholesterolemia and recently also for hyperlipidemia in renal disea ses, although in small series of patients and for short periods of tim e. Beyond their effects on lipids, statins may eventually reduce mesan gial cell proliferation, with a beneficial influence on proteinuria an d renal function in these patients. In order to ascertain these effect s, a long-term randomized clinical trial with pravastatin is proposed in patients with IMN presenting with NS and normal renal function.