医学
以兹提米比
肾病综合征
脂蛋白脂酶
代谢综合征
内科学
载脂蛋白B
PCSK9
血脂异常
脂蛋白
内分泌学
胆固醇
疾病
脂肪组织
低密度脂蛋白受体
肥胖
作者
Shipra Agrawal,Joshua J. Zaritsky,Alessia Fornoni,William E. Smoyer
标识
DOI:10.1038/nrneph.2017.155
摘要
Dyslipidaemia is a common consequence of nephrotic syndrome, and results in various cardiovascular and metabolic complications. In this Review, the authors discuss the mechanisms that underlie the development of dyslipidaemia, and the treatment options that are available to ameliorate its effects. Nephrotic syndrome is a highly prevalent disease that is associated with high morbidity despite notable advances in its treatment. Many of the complications of nephrotic syndrome, including the increased risk of atherosclerosis and thromboembolism, can be linked to dysregulated lipid metabolism and dyslipidaemia. These abnormalities include elevated plasma levels of cholesterol, triglycerides and the apolipoprotein B-containing lipoproteins VLDL and IDL; decreased lipoprotein lipase activity in the endothelium, muscle and adipose tissues; decreased hepatic lipase activity; and increased levels of the enzyme PCSK9. In addition, there is an increase in the plasma levels of immature HDL particles and reduced cholesterol efflux. Studies from the past few years have markedly improved our understanding of the molecular pathogenesis of nephrotic syndrome-associated dyslipidaemia, and also heightened our awareness of the associated exacerbated risks of cardiovascular complications, progressive kidney disease and thromboembolism. Despite the absence of clear guidelines regarding treatment, various strategies are being increasingly utilized, including statins, bile acid sequestrants, fibrates, nicotinic acid and ezetimibe, as well as lipid apheresis, which seem to also induce partial or complete clinical remission of nephrotic syndrome in a substantial percentage of patients. Future potential treatments will likely also include inhibition of PCSK9 using recently-developed anti-PCSK9 monoclonal antibodies and small inhibitory RNAs, as well as targeting newly identified molecular regulators of lipid metabolism that are dysregulated in nephrotic syndrome.
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