title: Statins in nephrotic syndrome: a new weapon against tissue injury.
abstract: The nephrotic syndrome is characterized by metabolic disorders leading to an increase in circulating lipoproteins levels. Hypertriglyceridemia and hypercholesterolemia in this case may depend on a reduction in triglyceride-rich lipoproteins catabolism and on an increase in hepatic synthesis of Apo B-containing lipoproteins. These alterations are the starting point of a self-maintaining mechanism, which can accelerate the progression of chronic renal failure. Indeed, hyperlipidemia can affect renal function, increase proteinuria and speed glomerulosclerosis, thus determining a higher risk of progression to dialysis. 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase is the rate-limiting enzyme in cholesterol synthesis from mevalonate and its inhibitors, or statins, can therefore interfere with the above-mentioned consequences of hyperlipidemia. Statins are already well known for their effectiveness on primary cardiovascular prevention, which cannot be explained only through their hypolipemic effect. As far as kidney diseases are concerned, statin therapy has been shown to prevent creatinine clearance decline and to slow renal function loss, particularly in case of proteinuria, and its favorable effect may depend only partially on the attenuation of hyperlipidemia. Statins may therefore confer tissue protection through lipid-independent mechanisms, which can be triggered by other mediators, such as angiotensin receptor blockers. Possible pathways for the protective action of statins, other than any hypocholesterolemic effect, are: cellular apoptosis/proliferation balance, inflammatory cytokines production, and signal transduction regulation. Statins also play a role in the regulation of the inflammatory and immune response, coagulation process, bone turnover, neovascularization, vascular tone, and arterial pressure. In this study, we would like to provide scientific evidences for the pleiotropic effects of statins, which could be the starting point for the development of new therapeutical strategies in different clinical areas.
authors.affiliation: Department of Internal Medicine, University of Messina, Messina, Italy. buemim@unime.it
authors.forename: Michele
authors.initials: M
authors.lastname: Buemi
authors.forename: Lorena
authors.initials: L
authors.lastname: Nostro
authors.forename: Eleonora
authors.initials: E
authors.lastname: Crascì
authors.forename: Antonio
authors.initials: A
authors.lastname: Barillà
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cosentini
authors.forename: Carmela
authors.initials: C
authors.lastname: Aloisi
authors.forename: Tito
authors.initials: T
authors.lastname: Sofi
authors.forename: Susanna
authors.initials: S
authors.lastname: Campo
authors.forename: Nicola
authors.initials: N
authors.lastname: Frisina
mesh_terms: D000818:Animals; D016723:Bone Remodeling / Q000187:drug effects; D018450:Disease Progression; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000517:prevention & control*; D006973:Hypertension / Q000188:drug therapy; D007109:Immunity; D007249:Inflammation / Q000517:prevention & control; D050356:Lipid Metabolism; D018919:Neovascularization, Physiologic / Q000187:drug effects; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D014664:Vasodilation / Q000187:drug effects
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors