I have in care a 3 year old girl affected by a cortico-resistant nephrotic syndrome, FSGS to the biopsy.
She was treated with steroid for months without any results. After a combined therapy CSA+MMF now she presents a mild response and the proteinuria is around 3-4 gr/24h.
A collateral problem in this case is the lipid profile. From the start she had very high values of triglycerides and Cholesterol: 500mg/dl and 800mg/dl respectively.
With very strict diet and Omega-3 fatty acid ethyl esters the tests improve (Cholesterol 670mg/dl and Triglycerides 230 mg/dl) but not satisfactorily.
I’ll try to change CNI but I don't think this is the problem. Meanwhile I’m not confident with Statins in so young patients.
In other cases, if I have hope to solve proteinuria in a short time, I can accept such dyslipidemia but in this case the situation is stable and the patient is likely to stay with high cholesterol and triglycerides values for many months.
Do you have any suggestions?
we are tied with not having enough evidence among our young children who end up having dyslipidemia early on. It always had been a huge challenge for pediatric nephrologist. All the recommendations /guidelines for pharmacological management of Dyslipidemia suggests treating over 8 yrs ( pravastatins), >10 yrs for other statins due to potential concern that exposure to these medications could potentially affect cholesterol dependent production of steroid hormones in the gonads and adrenal glands.when it come to treating our children 2-8 yrs we don't have much scientific evidences , as well as data on long term effects. Studies among older children are 5 yrs period. In pediatrics with ongoing dyslipidemia we don't know how long we will be treating them for?
These two studies have included
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