Article Text

  1. S. Annamraju,
  2. J. Dharmavaram,
  3. J. Gibson
  1. University of North Carolina, Raleigh, NC


Background/Purpose of Study Albuminuria is associated with increased risk of coronary heart disease, nephropathy, and death independently of renal function, hypertension, and diabetes. The American Diabetes Association (ADA) in its latest position statement recommends the use ofno-dihydropyridine calcium channel blockers, b-blockers,or diuretics for the managementof blood pressure in the setting ofalbuminuria or nephropathy, in diabetic patients unableto tolerate angiotensin-converting enzyme (ACE)inhibitors and/or angiotensin receptor blockers (ARBs). Even though statins have been shown to reduce albumin excretion, this role has not been thoroughly investigated.

Methods We present a case series of eight patients with type 2 diabetes mellitus and albuminuria who were started on lisinopril. After a mean dose of 20.6 mg of lisinopril for 6 weeks, a mean reduction of 46.6% in albuminuria was observed across the patient group. Dose-limiting side effects prevented further increases in doses of lisinopril. Treatment for hyperlipidemia and albuminuria prompted the initiation of statin therapy. Patients were started and maintained on 20 mg of simvastatin for 6 weeks.

Results After 6 weeks of therapy with simvastatin, the mean total reduction in albuminuria was 75.5% across the group. Thus, an additional mean reduction of 28.9% in albuminuria was noticed after treatment with simvastatin for 6 weeks. The magnitude of reduction in albuminuria did not have a direct correlation to the decrease in LDL cholesterol values.

Conclusions Despite earlier data suggesting that statins reduce albuminuria, there are no data proving the additive effects of statins in controlling albuminuria when added to a regimen containing ACE inhibitors. This case series demonstrated that simvastatin, over a short period of time, decreased albumin excretion significantly in patients already on lisinopril. Rigorously conducted clinical trials are necessary but this case series presents insight into the likely role of statins as reliable second-line agents to augment reduction in albuminuria when side effects preclude optimal dosing of ACE inhibitors in patients with diabetes mellitus and renal failure, an extremely common clinical scenario.

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