Multiple potency of ezetimibe in a patient with macroproteinuric chronic kidney disease and statin-intolerant dyslipidemia

Abstract

Dyslipidemia is often complicated by chronic kidney disease (CKD). Lipid-lowering medications may be effective, in part, for inhibiting development and progression of CKD. Ezetimibe, a cholesterol absorption inhibitor, has pleiotropic actions, including anti-inflammatory and anti-oxidant effects, contributing to a decreased risk of cardiovascular diseases. A 40-year-old woman was admitted with dyslipidemia and macroproteinuria, whose samples of renal biopsy showed exudative lesions, but without glomerular basement membrane thickening or nodular lesions, in some glomeruli. Blood glycemic parameters were normal. After initiation of atorvastatin, she developed muscle pain and an increase in serum creatine kinase. Twelve months after switching to ezetimibe, serum levels of low-density lipoprotein cholesterol and triglyceride reduced from 170mg/dL to 116mg/dL and from 320mg/dL to 160mg/dL, respectively. Although serum creatinine levels remained unchanged after 12months, urinary protein excretion and urinary liver-type fatty acid binding protein were reduced. Flow-mediated dilatation also increased from 4.9% to 5.5% after 12months, associated with a slight decrease in mean intima-media thickness in the common carotid artery from 0.722mm to 0.718mm. These results suggest that ezetimibe protects against renal and vascular damage in patients with CKD and statin-intolerant dyslipidemia.<Learning objective: Little is known whether ezetimibe monotherapy is safe and effective for renal/vascular function in patients with chronic kidney disease (CKD). We report that ezetimibe monotherapy for 12months improved lipid profiles in a patient with CKD and statin-intolerant dyslipidemia. Ezetimibe also reduced proteinuria and urinary liver-type fatty acid binding protein levels, improved endothelial function, and decreased carotid atherosclerosis. These findings suggest that ezetimibe monotherapy may have beneficial multipotent effects on renal/vascular function.>