Renoprotezione farmacologica nella nefropatia cronica proteinurica

Background. Proteinuria of Chronic Kidney Disease (CKD) is frequently associated to dyslipidemia, that increases the risk of renal and cardiovascular events. This might be ameliorated by drugs, such as ACEi or ARB, which effectively reduce proteinuria. Moreover, clinical and experimental studies provided evidence that statin exerts renoprotective effect, but their role in renal outcomes is still unclear. Methods. In this prospective, randomized trial, we evaluated if statin, combined to ACEi and ARB, more effectively than ACEi/ARB alone reduce proteinuria, and if this effect translate in a reduction of renal function decline. After 2 months of Benazepril/Valsartan combined therapy, 186 patients were randomized to 6 months Fluvastatin (80 mg/die) YES or NO additional therapy. Results. Benazepril/Valsartan therapy significantly and safely reduced proteinuria, total and LDL cholesterol. Fluvastatin addition optimised blood pressure control and effectively reduced proteinuria in nephrotic patients, in particular with diabetes. Renal function stabilised during Benazepril/Valsartan therapy alone, while more rapidly decreased with Fluvastatin addition, possibly via blood pressure reduction. Conclusion. In CKD patients with dyslipidemia, double RAS blockade is renoprotective and improves lipid profile through amelioration of nephrotic syndrome. Fluvastatin effectively improves renal outcomes only in nephrotic patients. Thus, Fluvastatin therapy must be reserved to this clinical setting.