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PEDIATRICS

The Potential Role of HMG-CoA Reductase Inhibitors in Pediatric Nephrotic Syndrome

Clinical Instructor, College of Pharmacy; Specialty Resident in Pediatric Pharmacotherapy, Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI

Darcie-ann D Streetman, PharmD

Clinical Assistant Professor, College of Pharmacy; Clinical Pharmacist, Department of Pharmacy Services, University of Michigan Health System

Daniel S Streetman, PharmD MS

Clinical Assistant Professor, Assistant Research Scientist; Head, Clinical Pharmacogenomics Laboratory, College of Pharmacy, University of Michigan Health System

Reprints: Darcie-ann D Streetman PharmD, University of Michigan Health System, Department of Pharmacy Services—Rm B2D301 University Hospital, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0008, fax 734/936-7027, darcieds{at}med.umich.edu

OBJECTIVE: To evaluate the safety and efficacy of the hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) as a potential treatment option for the dyslipidemia associated with childhood nephrotic syndrome.

DATA SOURCES: Searches of MEDLINE (1966–April 2004), Cochrane Library, International Pharmaceutical Abstracts (1977–April 2004), and an extensive manual review of journals were performed using the key search terms nephrotic syndrome, familial hypercholesterolemia, dyslipidemia, and HMG-CoA reductase inhibitor.

STUDY SELECTION AND DATA EXTRACTION: Two prospective uncontrolled studies evaluating the safety and efficacy of statin therapy in pediatric nephrotic syndrome were included.

DATA SYNTHESIS: While an extensive amount of data is available in adult nephrotic syndrome in which statin therapy decreases total plasma cholesterol 22–39%, low-density lipoprotein cholesterol (LDL-C) 27–47%, and total plasma triglycerides 13–38%, only 2 small uncontrolled studies have been conducted evaluating the utility of these agents in pediatric nephrotic syndrome. These studies indicate that statins are capable of safely reducing total cholesterol up to 42%, LDL-C up to 46%, and triglyceride levels up to 44%.

CONCLUSIONS: Lowering cholesterol levels during childhood may reduce the risk for atherosclerotic changes and may thus be of benefit in certain patients with nephrotic syndrome. Statins have demonstrated short-term safety and efficacy in the pediatric nephrotic syndrome population. Implementing pharmacologic therapy with statins in children with nephrotic syndrome must be done with care until controlled studies are conducted in this population.

Key Words: dyslipidemia, HMG-CoA reductase inhibitor, hypercholesterolemia, nephrotic syndrome

Published Online, October 26, 2004. www.theannals.com, DOI 10.1345/aph.1D587

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-04-039-H01

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