Hyperlipidemias: Cravedi P

Cravedi P, Ruggenenti P, Remuzzi G. · Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for Pharmacological Research, Bergamo, Italy. · J Ren Care. · Pubmed #19160879 No free full text.

Abstract: The level of proteinuria is one of the most important predictors for progressive renal function loss in kidney disease. Reduction of urinary protein levels by renin-angiotensin-system (RAS) inhibitors limits renal function decline in patients with non-diabetic and diabetic nephropathies to the point that remission of the disease and regression of renal lesions have been reported. The increasing use of these drugs is possibly at the basis of the stabilization of rates of new cases of kidney failure reported to the US Renal Data System after a 2-decade period of progressive increases. RAS inhibition, however, may not be effective to the same degree in all patients. For those patients who do not reach a complete remission of proteinuria, treatment procedures to implement renoprotection should include strict blood pressure control (and metabolic control in diabetics), lowering of blood lipids, and lifestyle modifications. Early intervention may be important to maximize renoprotection, especially in diabetics.

Cravedi P, Remuzzi G. · Clinical Research Centre for Rare Diseases Aldo e Cele Daccò, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica, Bergamo, Italy. · Kidney Int Suppl. · Pubmed #19034321 No free full text.

Abstract: The incidence of chronic renal and cardiovascular diseases is increasing worldwide. Since renal disease is the strongest risk factor for cardiovascular morbidity and mortality, strategies able to reduce renal disease progression are expected to translate into a decreased incidence of cardiovascular events. To this purpose, inhibition of the renin-angiotensin system, both by angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists, represents the best available option. Several large, randomized studies have convincingly shown that these treatments are associated with a significant reduction in the risk for renal disease progression in diabetic and non diabetic patients with chronic kidney disease. Importantly, improvement of renal outcomes is paralleled by a reduction of the cardiovascular risk. However, a significant proportion of patients with chronic nephropathies still progresses to end-stage renal failure or dies for cardiovascular events. A more complex strategy, including strict control of BP and proteinuria, lowering of blood lipids, tight metabolic control of diabetes, and lifestyle changes may improve morbidity and mortality of patients with chronic renal disease as compared with single or dual intervention on the renin-angiotensin system. Moreover, prevention strategies are urgently needed to face the burden of chronic renal disease and cardiovascular morbidity and mortality. This is particularly true for developing countries, where the incidence of these chronic diseases is growing with the highest rate.