Estatinas e microalbuminúria

Autores

  • Patrícia Dias Serviço de Medicina II dos Hospitais da Universidade de Coimbra
  • José Manuel Silva Serviço de Medicina II dos Hospitais da Universidade de Coimbra
  • Nuno Silva Serviço de Medicina II dos Hospitais da Universidade de Coimbra
  • M. B. Alexandrino Serviço de Medicina II dos Hospitais da Universidade de Coimbra
  • J. J. Alves de Moura Serviço de Medicina II dos Hospitais da Universidade de Coimbra

Palavras-chave:

microalbuminúria, estatinas, dislipidemia, nefropatia

Resumo

A microalbuminúria é, actualmente, considerada um indicador de risco cardiovascular,
ocorrendo frequentemente associada a outros
factores de risco aterosclerótico e podendo representar o marcador renal do aumento generalizado da permeabilidade endotelial que acompanha o processo aterogénico. Segundo
alguns estudos, a prevalência da microalbuminúria na população geral varia entre 3,8 e
14,6%, verificando-se prevalências mais elevadas nos diabéticos e ou hipertensos.
Evidências histopatológicas e experimentais
sugerem que a dislipidemia pode iniciar e contribuir para a progressão da nefropatia, sendo os mecanismos implicados semelhantes aos envolvidos na aterosclerose; por outro lado, a
perda urinária de albumina pode levar a elevação dos níveis plasmáticos das lipoproteínas
A terapêutica hipolipemiante com estatinas demonstrou reduzir o risco cardiovascular e,
também, melhorar a função endotelial. Estudos
em animais e in vitro demonstraram efeitos
benéficos destes fármacos em vários modelos de nefropatia, incluindo reduções da excreção
urinária de proteínas. Alguns estudos realizados em doentes com excreção anormal de proteínas na urina apoiam a hipótese de que os efeitos renoprotectores também ocorram em humanos, continuando, ainda em aberto, no
entanto, o campo para investigação nesta área, particularmente sobre o efeito das estatinas na redução da microalbuminúria.

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Referências

Deedwania PC. Hypertension and Diabetes. New therapeutic options. Arch Intern Med 2000;160:1585-1594.

Dinneen SF, Gerstein HC. The association of microalbuminuria and mortality in non-insulin dependent diabetes mellitus: a systemic overview of the literature. Arch Intern Med 1997;157:1413-1418.

Gerstein HC, Mann JF,Yi Q et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001;286:421-426.

Hillege HL, Janssen WM, Bak A et al. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med 2001;249:519-526.

Jensen JS. Microalbuminuria and the risk of atherosclerosis. Clinical epidemiological and physiological investigations. Danish Med Bull

;47(2):63-78.

Brown WW, Keane WF. Proteinuria and cardiovascular disease. Am J Kidney Dis 2001;38(4)Supl 1:S8-S13.

Mykkänen L, Haffner SM, Kuusisto J, Pyorälä K, Laakso M. Microalbuminuria precedes the development of NIDDM. Diabetes

;43:552-557.

Mykkänen L, Zaccaro DJ, Wagenknecht L, Robbins D, Gabriel M, Haffner S. Microalbuminuria is associated with insulin resistance in

nondiabetic subjects. The Insulin Resistance Atherosclerosis Study. Diabetes 1998;47:793-800.

Mykkänen L, Zaccaro DJ, O’Leary D, Howard G, Robbins D, Haffner S. Microalbuminuria and carotid artery intima-media thickness in non-diabetic and NIDDM subjects. The The Insulin Resistance Atherosclerosis Study(IRAS). Stroke 1997;28(9):1710-1716.

Feldt-Rasmussen B. Microalbuminuria, endothelial dysfunction and cardiovascular risk. Diab Metab (Paris) 2000;26:64-66.

Pontremoli R, Antonella S, Maura R et al. Prevalence and clinical correlates of microalbuminuria in essential hypertension: the MAGIC

Study. Hypertension 1997;30(5):1135-1143.

Keane WF. Metabolic Pathogenesis of Cardiorenal Disease. Am J Kidney Dis 2001;38(6):1372-1375.

Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage. The

Steno hypothesis. Diabetologia 1989;32:219-226.

Stehouwer C, Andreas Fischer HR, van Kuijk A, Polak B, Donker A. Endothelial dysfunction precedes the development of microalbuminuria in IDDM. Diabetes 1995;44:561-564.

Stehouwer C, Gall M, Twisk J, Knudsen E, Emeis J, Parving H. Increased urinary albumin excretion, endothelial dysfunction, and chronic

low-grade inflammation in type 2 diabetes: progressive, interrelated and independently associated with risk of death. Diabetes

;51:1157-1165.

Zenere B, Arcaro G, Saggiani F, Rossi L, Muggeo M, Lechi A. Noninvasive detection of functional alterations of the arterial wall in IDDM

patients with and without microalbuminuria. Diabetes Care 1995;18(7):975-982.

Bakris GL. Microalbuminuria: what is it? Why is it important? What should be done about it? J Clin Hypertens (Greenwich) 2001;3(2):99-

Spoelstra-de Man A, Brouwer C, Stehouwer C, Smulders Y. Rapid progression of albumin excretion is an independent predictor of cardiovascular mortality in patients with type 2 diabetes and microalbuminuria. Diabetes Care 2001;24:2097-2101.

Metcalf P, Scragg R. Epidemiology of microalbuminuria in the general population. J Diabetes Complications 1994;8:157-163.

Vestbo E, Damsgaard EM, Froland A, Mogensen CE. Urinary albumin excretion in a population based cohort. Diabetic Medicine 1995;12:488-493.

Sawicki PT, Heinemann L, Berger M. Comparison of methods for determination of microalbuminuria in diabetic patients. Diabetic Medicine.1989;6:412-415.

Cirillo M, Senigalliesi L, Laurenzi M. Microalbuminuria in nondiabetic adults: relation of blood pressure, body mass índex, plasma cholesterol levels and smoking: The Gubbio Population Study. Arch Intern Med 1998;158:1933-1939.

Haffner SM, Stern MP, Gruber MK, Hazuda HP, Mitchel BD, Patterson JK. Microalbuminuria. Potential marker for increased cardiovascular risk factors in nondiabetic subjects? Arteriosclerosis 1990;10(5):727-731.

Winocour PH, Harland JO, Millar JP, Laker MF, Alberti KG. Microalbuminuria and associated cardiovascular risk factors in the community. Atherosclerosis 1992;93(1-2):71-81.

Metcalf PA, Baker JR, Scragg R, Dryson E, Scott A, Wild C. Microalbuminuria in a middle-aged workforce. Effect of hyoerglycemia and

ethnicity. Diabetes Care 1993;16(11):1485-1493.

Tomura S, Kawada K, Saito K et al. Prevalence of microalbuminuria and relationship to the risk of cardiovascular disease in the japanese

population. Am J Nephrol 1999;CAPut!’:13-20.

Bonet J, Vila J, Alsina MJ, Ancochea L, Romero R. Prevalencia de microalbuminuria en la población general de un área mediterránea española y su asociación con otros factores de riesgo cardiovascular. Med Clin (Barc) 2001;116:573-574.

Jones CA, Francis ME, Eberhardt MS et al. Microalbuminuria in the US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2002;39(3):445-459.

Wanner C. Importance of hyperlipidaemia and therapy in renal patients. Nephrol Dial Transplant 2000;15(5):92-96.

Takemura T, Yoshioka K, Aya N et al. Apolipoproteins and lipoprotein receptors in glomeruli in human kidney diseases. Kidney Int

;43:918-927.

Hegele RA, Harris SB, Zinman B, Hanley A, Connely P. Increased plasma apolipoprotein B-containing lipoproteins associated with increased urinary albumin within the microalbuminuria range in type 2 diabetes. Clinical Biochemistry 1999;32(2):143-148.

Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag M. Plasma lipids and risk of developing renal dysfunction : the Atherosclerosis Risk in Communuties Study. Kidney Int 2000;58:293-301.

Yukawa S, Mune M, Yamada Y, Otani H, Kishino M, Tone Y. Ongoing clinical trials of lipid reduction therapy in patients with renal disease.

Kidney Int.1999;56 (71):S141-S143.

Yoshino G, Hirano T, Kazumi T. Atherogenic lipoproteins and diabetes mellitus. J Diabetes Complications 2002;16:29-34.

Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R. Main risk factors for nephropaty in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure and hypergly cemia. Arch Intern Med 1998;158:998-1004.

Wanner C, Quaschning T. Dyslipidemia and renal disease: pathogenesis and clinical consequences. Curr Opin Nephrol Hypertens.2001;10:195-201.

Diamond JR. Analogous pathobiological mechanisms in glomerulosclerosis and atherosclerosis. Kidney Int 1991;39(31):S29-S34.

Oda H, Keane WF. Recent advances in statins and the kidney. Kidney Int 1999;56(71):S2-S5.

Harris K, Purkerson M, Yates J, Klahr S. Lovastatin ameliorates the development of glomerulosclerosis and uremia in experimental nephrotic syndrome. Am J Kidney Dis 1990;15(1):16-23.

Jandeleit-Dahm K, Cao Z, Cox A, Kelly D, Gilbert R, Cooper M. Role of hyperlipidemia in progressive renal disease: focus on diabetic nephropathy. Kidney Int 1999 ;56(71) :S31-S36.

Park JK, Muller DN, Mervaala E et al. Cerivastatin prevents angiotensinII-induced renal injury independent of blood pressure- and cholesterol-lowering effects. Kidney Int 2000;58:1420-1430.

Shoji T, Nishizawa Y, Toyokawa A, Kawagishi T, OkunoY, Morii H. Decreased albuminuria by pravastatin in hyperlipidemic diabetics.

Nephron 1991;59:664-665.

Hommel E, Andersen P, Gall MA et al. Plasma lipoproteins and renal function during simvastatin treatment in diabetic nephropathy. Diabetologia 1992;35:447-451.

Nielsen S, Schmitz O, Moller N et al. Renal function and insulin sensitivity during simvastatin treatment in type 2 (non insulin dependent)

diabetic patients with microalbuminuria. Diabetologia 1993;36:1079-1086.

Thomas M, Harris K, Ramaswamy C et al. Simvastatin therapy for hypercholesterolemic patients with nephrotic syndrome or significant

proteinuria. Kidney Int 1993;44:1124-1129.

Lam K, Cheng I, Janus E, Pang R. Cholesterol-lowering therapy may retard the progression of diabetic nephropathy. Diabetologia

;38:604-609.

Zhang A, Vertommen J, Van Gaal L, De Leeuw I. Effects of pravastatin on lipid levels, in vitro oxidizability of non-HDL lipoproteins and

microalbuminuria in IDDM patients. Diabetes Res Clin Pract 1995;29:189-194.

Rayner BL, Byrne, MJ, van Zyl Smit R. A prospective clinical trial comparing the treatment of idiopathic membranous nephropathy and

nephrotic syndrome with simvastatin and diet, versus diet alone. Clin Nephrol 1996;46:219-224.

Tonolo G, Ciccarese M, Brizzi P et al. Reduction of albumin excretion rate in normotensive microalbuminuric type 2 diabetic patients during

long-term simvastatin treatment. Diabetes Care 1997;20:1891-1895.

Buemi M, Allegra A, Corica F et al. Effect of fluvastatin on proteinuria in patients with immunoglobulin A nephropathy. Clin Pharmacol Ther

;67:427-431.

Velussi M, Cernigoi, Tortul C, Merni M. Atorvastatin for the management of type 2 diabetic patients with dyslipidemia. A mid-term (9

months) treatment experience. Diab Nutr Metab 1999:407-412.

Fried L, Forrest K, Ellis D, Chang Y, Silvers N, Orchard T. Lipid modulation in insulin-dependent diabetes mellitus. Effect on microvascular outcomes. J Diabetes Complications 2001;15:113-119.

Diercks G, Janssen W, van Boven A et al. Rationale, design, and baseline characteristics of a trial of prevention of cardiovascular and renal

disease with fosinopril and pravastatin in nonhypertensive, nonhypercholesterolemic subjects with microalbuminuria (the Prevention of

REnal and Vascular ENdstage Disease Intervention Trial [PREVEND IT]). Am J Cardiol 2000;86:635-638.

Nakamura T, Ushiyama C, Hirokawa K, Osada S, Shimada N, Koide H. Effect of cerivastatin on urinary albumin excretion and plasma endothelin-1 concentrations in type 2 diabetes patients with microalbuminuria and dyslipidemia. Am J Nephrol 2001;21:449-454.

Fried L, Orchard T, Kasiske B.. Effect of lipid reduction on the progression of renal disease: a meta-analysis. Kidney Int 2001;59:260-

Campese V, Bianchi S, Bigazzi R. Association between hyperlipidemia and microalbuminúria in essential hypertension. Kidney Int

;56(71):S10-S13.

LaRosa J, He J, Vupputri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA

;282:2340-2346.

Amerongen G, Vermeer M, Nègre-Aminou P, Lankelma J, Emeis J, Hinsbergh V. Simvastatin improves disturbed endothelial barrier function. Circulation 2000;102:2803-2809.

Tsunekawa T, Hayashi T, Kano H et al. Cerivastatin, a hydroxymethylglutaryl coenzyme A reductase inhibitor, improves endothelial function in elderly diabetic patients within 3 days. Circulation 2001;104:376-379

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Publicado

30-06-2003

Como Citar

1.
Dias P, Silva JM, Silva N, Alexandrino MB, Alves de Moura JJ. Estatinas e microalbuminúria. RPMI [Internet]. 30 de Junho de 2003 [citado 4 de Outubro de 2024];10(2):101-9. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/1804

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