Do Statins Protect the Kidney by Reducing Proteinuria?
Authors: Marcello Tonelli
Journal: Annals of Internal Medicine (2006)

Editorials18 July 2006Do Statins Protect the Kidney by Reducing Proteinuria?Marcello Tonelli, MD, SMMarcello Tonelli, MD, SMFrom University of Alberta and Institute of Health Economics, Edmonton, Alberta T6G 2G3, Canada.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-2-200607180-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The first time someone proposed that dyslipidemia caused progressive kidney disease was more than a century ago (1). The proposal has support from experimental and clinical evidence (2), and some have suggested that lipid-modifying medication may reduce proteinuria and prevent kidney function loss. This editorial focuses on statins, which have been the most extensively studied class of lipid-lowering drug.A recent systematic review of 27 randomized trials (with a total of 39 704 participants) suggested that statins reduce the rate of kidney function loss by 1.2 mL/min per year (95% CI, 0.4 to 2.0 mL/min per year), which is equivalent to ...References1. Virchow R. Cellular Pathology. 2nd ed. England: Gryphonham Gryphon Editions; 1860:324-66. Google Scholar2. Afzali B, Haydar AA, Vinen K, Goldsmith DJ. From Finland to fatland: beneficial effects of statins for patients with chronic kidney disease. J Am Soc Nephrol. 2004;15:2161-8. [PMID: 15284301] CrossrefMedlineGoogle Scholar3. Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol. 2006 [Forthcoming]. Google Scholar4. Douglas K, O'Malley PG, Jackson JL. Meta-analysis: the effect of statins on albuminuria. Ann Intern Med. 2006;145:117-24. LinkGoogle Scholar5. O'Driscoll G, Green D, Taylor RR. Simvastatin, an HMG-coenzyme A reductase inhibitor, improves endothelial function within 1 month. Circulation. 1997;95:1126-31. [PMID: 9054840] CrossrefMedlineGoogle Scholar6. Remuzzi G, Bertani T. Pathophysiology of progressive nephropathies. N Engl J Med. 1998;339:1448-56. [PMID: 9811921] CrossrefMedlineGoogle Scholar7. Agarwal R. Statin induced proteinuria: renal injury or renoprotection? [Editorial]. J Am Soc Nephrol. 2004;15:2502-3. [PMID: 15340001] CrossrefMedlineGoogle Scholar8. Zoja C, Corna D, Rottoli D, Cattaneo D, Zanchi C, Tomasoni S, et al. Effect of combining ACE inhibitor and statin in severe experimental nephropathy. Kidney Int. 2002;61:1635-45. [PMID: 11967013] CrossrefMedlineGoogle Scholar9. Zoja C, Corna D, Camozzi D, Cattaneo D, Rottoli D, Batani C, et al. How to fully protect the kidney in a severe model of progressive nephropathy: a multidrug approach. J Am Soc Nephrol. 2002;13:2898-908. [PMID: 12444208] CrossrefMedlineGoogle Scholar10. de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int. 2004;65:2309-20. [PMID: 15149345] CrossrefMedlineGoogle Scholar11. Vidt DG, Cressman MD, Harris S, Pears JS, Hutchinson HG. Rosuvastatin-induced arrest in progression of renal disease. Cardiology. 2004;102:52-60. [PMID: 15073451] CrossrefMedlineGoogle Scholar12. Sidaway JE, Davidson RG, McTaggart F, Orton TC, Scott RC, Smith GJ, et al. Inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase reduce receptor-mediated endocytosis in opossum kidney cells. J Am Soc Nephrol. 2004;15:2258-65. [PMID: 15339975] CrossrefMedlineGoogle Scholar13. Shepherd J, Wenger N. Intensive lipid lowering with atorvastatin is associated with a significant improvement in renal function: the Treating to New Targets (TNT) Study [Abstract]. Presented at American College of Cardiology 2006 Scientific Sessions, Atlanta, Georgia, 13 March 2006. Abstract no. 808-3. Google Scholar14. Baigent C, Landry M. Study of Heart and Renal Protection (SHARP). Kidney Int Suppl. 2003;:S207-10. [PMID: 12694346] CrossrefMedlineGoogle Scholar15. Tonelli M, Isles C, Curhan GC, Tonkin A, Pfeffer MA, Shepherd J, et al. Effect of pravastatin on cardiovascular events in people with chronic kidney disease. Circulation. 2004;110:1557-63. [PMID: 15364796] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Alberta and Institute of Health Economics, Edmonton, Alberta T6G 2G3, Canada.Acknowledgments: The author thanks Drs. Barbara Ballermann and Neesh Pannu for their helpful suggestions.Grant Support: Dr. Tonelli was supported by salary awards from the Canadian Institutes of Health Research and the Alberta Heritage Foundation for Medical Research.Disclosures: Dr. Tonelli received a research grant (>$10 000) from Bristol-Myers Squibb in 2003, served on a Pfizer advisory board in 2004, received honoraria (<$10 000) from Pfizer for continuing medical education lectures in 2004–2005, and received a research grant from AstraZeneca (<$10 000) in 2005. Honoraria (<$10 000) provided by Merck and AstraZeneca for academic grand rounds given in 2006 were paid directly to charity.Corresponding Author: Marcello Tonelli, MD, SM, 7-129 Clinical Sciences Building, 8440-112 Street, Edmonton, Alberta T6G 2G3, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEfficacy of Statin Treatment in Early-Stage Chronic Kidney DiseaseEpidemiology and Mechanisms of Uremia-Related Cardiovascular DiseaseTargeting of RhoA/ROCK Signaling Ameliorates Progression of Diabetic Nephropathy Independent of Glucose ControlHet breder en doelmatiger gebruik van statinen 18 July 2006Volume 145, Issue 2Page: 147-149KeywordsCreatinineExcretionKidneysProteinsProteinuriaRenal diseasesRenal failureStatinsSystematic reviews ePublished: 18 July 2006 Issue Published: 18 July 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...