Dyslipidemia in pediatric renal disease: epidemiology, pathophysiology, and management.
Dyslipidemia increases the risk of cardiovascular events among individuals with renal disease, and there is a growing body of evidence that it hastens the progression of renal disease itself. Children with nephrotic syndrome or renal transplants have easily recognized hyperlipidemia. Among those with chronic renal insufficiency or end-stage renal disease, detection of dyslipidemia requires more careful analysis and knowledge of normal pediatric ranges. Disordered lipoprotein metabolism results from complex interactions among many factors, including the primary disease process, use of medications such as corticosteroids, the presence of malnutrition or obesity, and diet. The systematic treatment of dyslipidemia in children with chronic renal disease is controversial because conclusive data regarding the risks and benefits are lacking. Hepatic 3-methylglutaryl coenzyme A reductase inhibitors (statins), fibrates, plant stanols, bile acid-binding resins, and dietary manipulation are options for individualized treatment. Prospective investigations are required to guide clinical management.
Saland
Jeffrey M
JM
Department of Pediatrics, The Mount Sinai Medical Center, New York, New York 10029-6574, USA. salanj01@doc.mssm.edu
Ginsberg
Henry
H
Fisher
Edward A
EA
D001161:Arteriosclerosis / Q000517:prevention & control; D002648:Child; D018450:Disease Progression; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications*; D016030:Kidney Transplantation; D009404:Nephrotic Syndrome / Q000150:complications*
D000960:Hypolipidemic Agents