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J R Soc Med. 2001 July; 94(7): 369–370.
PMCID: PMC1281618

Diabetic nephropathy and dyslipidaemia

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.

References

1. Jandeleit-Dahm K, Cao Z, Cox AJ, et al. Role of hyperlipidemia in progressive renal disease: focus on diabetic nephropathy. Kidney Int 1999;71(suppl): S31-6 [PubMed]
2. Inman SR, Stowe NT, Cressman MD, et al. Lovastatin preserves renal function in experimental diabetes. Am J Med Sci 1999;317: 215-21 [PubMed]
3. Yukawa S, Mune M, Yamada Y, Otani H, Kishino M, Tone Y. Ongoing clinical trials of lipid reduction therapy in patients with renal disease. Kidney Int 1999;71(suppl): S141-3 [PubMed]
4. Lam KS, Cheng JK, Janus ED, Pang RW. Cholesterol-lowering therapy may retard the progression of diabetic nephropathy. Diabetologia 1995;38: 604-9 [PubMed]
5. Fried LF, Orchard TJ, Kasiske BL. Effect of lipid reduction on the progression of renal disease: a meta-analysis. Kidney Int 2001;59: 260-9 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press