Effect of lifestyle modification and atorvastatin on dyslipidemia and endothelial dysfunction markers in children with steroid resistant nephrotic syndrome

Abstract

Introduction: Persistent dyslipidemia in children with steroid resistant nephrotic syndrome (SRNS) causes endothelial dysfunction resulting in adverse cardiovascular outcomes. Methods: Thirty-four patients aged 4–18 years newly diagnosed with SRNS and no previous statin use were enrolled in this longitudinal observational study. Serum levels of total cholesterol, LDL cholesterol, and endothelial dysfunction markers (PSCK-9, E-selectin) were measured at baseline and after 12 weeks of lifestyle modifications in all patients, and atorvastatin was prescribed to those with LDL-cholesterol > 160 mg/dL. Primary outcome measure was change in plasma levels of total cholesterol, LDL cholesterol, PSCK-9, and E-selectin at 12 weeks. The secondary outcome was the correlation of PSCK-9 and E-selectin with lipid profile, blood pressure, BMI, serum albumin, and urine-protein creatinine ratio. Results: There was a significant decline in total cholesterol, LDL cholesterol, E-selectin, and PCSK-9 levels at 12 weeks of lifestyle modification and atorvastatin therapy. In a subgroup analysis between the statin group (n = 16) and the non-statin group (n = 18), both groups showed a significant decline in lipid profile parameters with a more pronounced decline in the statin subgroup. Endothelial dysfunction markers (E-selectin and PSCK-9) showed a declining trend in both subgroups, but the decline was not statistically significant in the statin group. Conclusion: Dietary and lifestyle modifications led to a decline in endothelial dysfunction markers and an improvement in lipid profile. Statins helped improve dyslipidemia but did not significantly improve endothelial dysfunction markers at 12 weeks.