Corna Daniela, Sangalli Fabio, Cattaneo Dario, Carrara Fabiola, Gaspari Flavio, Remuzzi Andrea, Zoja Carla, Benigni Ariela, Perico Norberto, Remuzzi Giuseppe
Mario Negri Institute for Pharmacological Research, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Am J Nephrol. 2007;27(6):630-8. doi: 10.1159/000108359. Epub 2007 Sep 11.
Evidence is accumulating that statins can reduce proteinuria and disease progression in chronic kidney disease. However, some safety concerns have been recently raised on the use of these agents, mainly due to transient episodes of proteinuria observed in patients receiving high doses of rosuvastatin.
We investigated in rats with renal mass ablation (RMR) whether rosuvastatin (5 or 20 mg/day) worsens proteinuria as compared to untreated RMR animals. Moreover, we also examined whether rosuvastatin-induced changes in proteinuria would be due to the effect of the drug on permselective properties of glomerular capillary barrier, measured by the fractional clearance of graded-size Ficoll molecules and/or by proximal tubular mechanisms, by assessing urinary excretion of beta(2)-microglobulin.
RMR rats given rosuvastatin for 28 days showed a progressive increase in proteinuria, with values numerically but not significantly higher than those in RMR animals given the vehicle. In RMR rats, rosuvastatin did not significantly affect the fractional clearance of Ficoll as compared to vehicle-treated RMR animals. A significant correlation was found between urinary protein and beta(2)-microglobulin excretion in rats treated with rosuvastatin (r = 0.936, p < 0.001), but not in those given vehicle. Renal function, glomerular and tubulointerstitial injury were comparable in rosuvastatin-treated and untreated RMR rats at the end of the 28-day follow-up.
In rats with RMR, rosuvastatin mildly enhances urinary protein excretion rate. This, however, was not the result of further changes in the size-permselective function of glomerular capillary barrier.
越来越多的证据表明,他汀类药物可减少慢性肾脏病患者的蛋白尿并延缓疾病进展。然而,近期对这类药物的使用引发了一些安全性担忧,主要是因为接受高剂量瑞舒伐他汀治疗的患者出现了短暂性蛋白尿。
我们在肾大部切除(RMR)大鼠中研究了瑞舒伐他汀(5或20毫克/天)与未治疗的RMR动物相比是否会加重蛋白尿。此外,我们还通过评估β2-微球蛋白的尿排泄量,研究了瑞舒伐他汀诱导的蛋白尿变化是否归因于药物对肾小球毛细血管屏障选择通透性的影响(通过分级大小的菲可分子的分数清除率测量)和/或近端肾小管机制。
给予瑞舒伐他汀28天的RMR大鼠蛋白尿逐渐增加,数值上高于给予赋形剂的RMR动物,但无显著差异。与给予赋形剂的RMR动物相比,瑞舒伐他汀对RMR大鼠菲可分子的分数清除率无显著影响。在接受瑞舒伐他汀治疗的大鼠中,尿蛋白与β2-微球蛋白排泄之间存在显著相关性(r = 0.936,p < 0.001),而给予赋形剂的大鼠则无此相关性。在28天随访结束时,瑞舒伐他汀治疗组和未治疗组的RMR大鼠的肾功能、肾小球和肾小管间质损伤相当。
在RMR大鼠中,瑞舒伐他汀轻度提高尿蛋白排泄率。然而,这并非肾小球毛细血管屏障大小选择通透性功能进一步改变的结果。