title: Amelioration of steroids and cyclosporine-resistant nephrotic syndrome by pravastatin.
abstract: We report the case of a girl with steroids and cyclosporine (CsA) resistant focal segmental glomerulosclerosis (FSGS) whose proteinuria and hypoproteinaemia were dramatically resolved by pravastatin. She had been in a nephrotic condition for 6 years. Prednisolone, pulse methylprednisolone therapy, low-density lipoprotein (LDL) apheresis, CsA, cyclophosphamide and mizoribine (MZR) had proved to be ineffective. She was started on pravastatin for her hyperlipidaemia 6 and a half years from onset, in addition to the baseline therapy, which included CsA; remission of the nephrotic syndrome was unexpectedly attained after 10 months of treatment. The baseline therapy has not been changed since the inclusion of pravastatin. This case suggests that, in patients with hyperlipidaemia, the response to CsA could be restored by lowering cholesterol levels with statins. The decrease of cholesterol levels might have improved the pharmacokinetics of CsA in this patient. Furthermore, the anti-inflammatory and immuno-modulatory effects, recently attributed to statins, may also have been involved in the improvement experienced by our patient.
authors.affiliation: Children's Medical Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan. hi5-si@urahp.yokohama-cu.ac.jp
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ito
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Machida
authors.forename: Aya
authors.initials: A
authors.lastname: Inaba
authors.forename: Tomonori
authors.initials: T
authors.lastname: Harada
authors.forename: Kenichi
authors.initials: K
authors.lastname: Okuyama
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yukoh
authors.initials: Y
authors.lastname: Aihara
authors.forename: Shumpei
authors.initials: S
authors.lastname: Yokota
mesh_terms: D000293:Adolescent; D016572:Cyclosporine / Q000494:pharmacology*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000517:prevention & control; D017035:Pravastatin / Q000627:therapeutic use*; D012074:Remission Induction; D013256:Steroids / Q000494:pharmacology*
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D017035:Pravastatin