Hyperlipidemia due to Nephrotic Syndrome: Its Effects and Effects of Interventions on Atherogenesis, Cardiovascular and Renal Outcomes

Nephrotic syndrome (NS) is one of the most important causes of secondary hyperlipidemia. Here, I describe characteristics and mechanisms for hyperlipidemia due to NS, and systematically reviewed the association of such hyperlipidemia with atherosclerotic progression and the development of cardiovascular diseases (CVD) by Pubmed. Further, I searched literatures on the effects of interventions including diet, statin, fibrates, low-density lipoprotein (LDL)-apheresis and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on hyperlipidemia and cardiovascular and renal outcomes in NS patients. Although dyslipidemia may be associated with atherosclerosis in NS, other factors such as age, duration of disease, number of relapses and blood pressure are also crucial determinants of atherosclerosis. The disease-specific risk of thromboembolism was different across the histological groups. One cohort study suggested that persons with NS are at increased risk of coronary heart disease (CHD). Among various interventions for NS, statin is relatively safe and effective for hyperlipidemia due to NS, but, it does not show sufficient evidence for cardiovascular and renal outcomes. Although PCSK9 inhibitors are promising therapeutic options for NS, large-scale trials are needed to elucidate such effect. J Endocrinol Metab. 2020;10(3-4):63-73 doi: https://doi.org/10.14740/jem663