Hyperlipidemia of the nephrotic syndrome is a risk factor for the development of systemic artherosclerosis, also it may aggravate glomerulosclerosis and enhance the progression of glomerular disease.1,2,7
Pattern of dyslipidemia in our cases is matching with that reported by Wheeler16
and Warwick et al.17
who showed that total plasma cholesterol; TG, VLDL, and LDL were elevated, with variable HDL concentration.
We observed significant reduction of serum cholesterol by 28.8% and 30.2% at 6 months and at 1 year of M. purpureus
Went rice, possibly due to its HMG-CoA reductase inhibiting properties.3–5
In contrast, there were no significant changes in serum cholesterol in the control group.
Similar findings were reported by Matzkies et al.18
who showed a reduction of total cholesterol by 31% and LDL by 29% after 2 months of initiation of fluvastatin treatment (40 mg/day). The relatively small number of cases (10 cases) as well as the large dosage of fluvastatin they used might explain the earlier reduction in LDL and cholesterol they observed. Also, our observation goes hand in hand with the degree of reduction in total and LDL cholesterol reported by Olbricht et al.19
on using simvastatin with nephrotic patients. Todd and Goa20
achieved a 25-30% reduction in plasma LDL within 4 weeks which was maintained with continued treatment by a daily dose of 20-40 mg fluvastatin. Jokubaitis21
reported similar findings by fluvastatin in a dose of 40 mg/day.
In this study, we succeeded in reducing cholesterol by the same degree after 6 months of fluvastatin (20 mg per day) and - for the first time in nephrotic patients - by M. purpureus (600 mg per day) therapies, without side effects and with relatively lower dosage.
In the same direction, Lin et al.8
reported short-term efficacy and safety of M. purpureus
went rice in treating hyperlipidemia.
Interestingly, a significant reduction in proteinuria was observed in the statin and M.
Went rice treated patients, but not in the control group. Matzkies et al.18
in a similar study - with statin failed to demonstrate such favorable effect. This may be explained by the fact that Matzkies' patients were of heterogeneous pathologic types while most of our patients were suffering from FSGS.
In the same direction, Hattori et al.22
reported that there was an improvement in renal function and proteinuria in drug resistant NS secondary to FSGS, by LDL apheresis combined with pravastatin. In placebo-controlled study performed in Hong-Kong over 2 years, it was suggested that despite no significant effect on proteinuria a decline in renal function was attenuated by lovastatin, particularly over the second year of the study.23
Chan et al.24
reported that in lovastatin-treated nephrotics with relatively good pretreatment renal function, glomerular filtration rate (GFR) increased at the end of 6 months treatment.
In contrast, Matzkies et al.18
reported a significant rise in serum creatinine in their patients despite using fluvastatin in a dose of 40 mg/day. Again, the heterogeneity of pathologic types of their patients explains the difference in their results.
In this study, the significant reduction of creatinine clearance among control group 6 months onward compared to the nonsignificant change of creatinine clearance in M. purpureus Went rice and statin-treated groups, both suggested the protective effect of lipid-lowering agents on kidney function. Also, the electromyographic data showed a significant decrease in the amplitude and duration of MUP in the proximal muscles only with statin treatment compared to basal values. These changes were not observed in M. purpureus. However, this reduction was not excessive and there was no other electromyographic evidence of myopathy. In addition, there were no clinical findings of myopathy or elevated serum CPK.
similarly noted that drug-related myopathy and rhabdomyolysis have not been reported with fluvastatin on the basis only of clinical findings and elevated skeletal muscle enzymes. In the same direction, Jokubaitis21
found no notable increase in serum CPK or liver enzymes, and no cases of clinically evident myopathy. On the other hand, Careless and Cohen26
reported that statins and fibrates were associated with a variety of rheumatic problems including proximal myopathy, diagnosed on a clinical basis and confirmed by high serum CPK. Jacquet et al.27
also reported that the frequency of severe side effects such as myopathy amounted to 1 per 1000 prescriptions with cholesterol-lowering drugs in current use. De Pinieux et al.
ascribed the myopathic side effects of statins to mitochondrial dysfunction as the blood lactate/pyruvate ratio is high.28
These reports regarding the safety of statins were based only on clinical data and muscle enzyme evaluation.
Jacobson et al.29
reported increase in liver enzymes while Olbricht et al.19
and Matzkies et al.18
reported satisfactory tolerance of statin in their nephrotics.
In agreement with what was reported by Lin et al.8
, M. purpureus
Went rice was well tolerated in patients with hyperlipidemia. Moreover, we found that M. purpureus
Went rice was not only an efficacious modality of treatment that targeted the nephrotic dyslipidemia with the same potency like statin, but also achieved 50% cost reduction in comparison to fluvastatin. From this study, we can conclude that M. purpureus
Went rice is safe, effective, and economic treatment strategy for nephrotic dyslipidemia.