Based on animal experiments, it has been
postulated that hyperlipidemia may contribute to the development of
renal injury in patients with essential hypertension or with primary
renal diseases. Support for this hypothesis in humans was presented by
Klag et al (84/393) and by Samuelsson et al. (83/402 and 85/402). Using
the MRFIT data base and the HCFA ESRD registry, Klag et al. showed that,
over an average 16 year follow up, serum cholesterol in 332,544 subjects
screened for the MRFIT trial (all men) had a graded relationship to the
development of ESRD. Compared to men with serum cholesterol < 200
mg/dl, the relative risk of ESRD in men with cholesterol greater than
240 mg/dl was 1.43 (confidence interval 1.2, 1.7). In 43 patients with
chronic GN, Samuelsson et al. found serum cholesterol, LDL-cholesterol,
and LDL/HDL ratio to correlate with higher rates of progression of renal
failure. In diabetics, higher rates of progression were associated with
increased LDL and LDL/HDL ratio. Taken together, these studies suggest
that lowering elevated serum cholesterol may preserve renal function in
hypertension, chronic GN and diabetic nephropathy. (Vardaman M.
Buckalew, Bowman Grey School of Medicine, Winston-Salem, NC)
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