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In their review article on diabetic nephropathy (May 2001 JRSM, pp. 210-217), Dr Foggensteiner and his colleagues refer to ‘compelling reasons for the aggressive management of dyslipidaemia’ in this condition. They focus on the benefits of lipid-lowering to prevent cardiovascular disease in these patients, but the benefits specific to renal function also deserve consideration. In both diabetic and non-diabetic animal models, statin therapy has decreased glomerular injury and the rate of decline in glomerular filtration rate (GFR)1. These effects may be mediated by the action of statins on prosclerotic cytokines rather than their lipid-lowering properties2. However, among non-diabetic individuals, renal function declines more slowly in those with low ratios of low-density lipoprotein to high-density lipoprotein cholesterol3, and in diabetic patients normalization of hypercholesterolaemia may retard the progression of nephropathy4. A meta-analysis of thirteen prospective controlled trials supports the idea that lipid reduction preserves GFR and reduces proteinuria5.
Although several studies on lipid-lowering in diabetic nephropathy have been inconclusive, possibly because of short follow-up time or small sample size, others have shown benefit from aggressive management. Primary prevention studies are necessary to determine the specific effects of lipid management on diabetic nephropathy.