Effects of fluvastatin treatment on lipid profile, C-reactive protein trend, and renal function in dyslipidemic patients with chronic renal failure.

The purpose of this trial was to evaluate the effects of fluvastatin on the lipid pro-file and on renal function, as measured by creatinine clearance, in dyslipidemic patients with chronic renal failure. In this 8-month prospective, open-label, randomized, parallel-group trial, 130 patients (70 men and 60 women), after a 2-month washout period following previous lipid-lowering treatments, were randomly assigned to fluvastatin XL 80 mg given once daily (80 patients) or to standard treatment (50 patients). Mean total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride values after 3 and 6 months of treatment with fluvastatin showed statistically significant improvement compared with standard treatment. Improved renal function, as measured by creatinine clearance, was observed at the end of the 6-month treatment period in approximately 65% of patients treated with fluvastatin. The increase in creatinine clearance consistently reached 10% to 15% of baseline values. A statistically significant reduction in C-reactive protein (CRP) over baseline values was observed in approximately 75% of patients treated with fluvastatin. Furthermore, mean values of CRP for the fluvastatin standard treatment groups, respectively, were 6.78 and 10.19 at 3 months and 4.47 and 11 at 6 months. Both treatments were well tolerated. No major adverse events were noted. Results of this study suggest that fluvastatin treatment in patients with chronic renal failure is effective in improving the lipid profile, and it demonstrates good safety and tolerability. Furthermore, fluvastatin may contribute to improved nephroprotection in this patient population.

[Synchronous adenomas of the stomach and rectum with severe protein-losing syndrome]. / Adenomi sincroni dello stomaco e del retto con grave sindrome da proteinodispersione.

The authors report a case of generalized edema with low colloidal osmotic pressure of plasma in an elderly man. After the exclusion of malnutrition and any myocadic, renal or hepatic involvement it has been shown that the physiopathogenetic mechanism is based on protein-losing enteropathy. Upper and lower endoscopy of the gastrointestinal tract reveals double synchronous villous adenomas of the rectum and stomach (the latter rare but often associated with the former). It is likely that these two lesions may play an important role in the development of "anasarca" but only complete reversal of symptoms after surgical excision of tumors would demonstrate the causative relationship. The study confirms two findings already observed in the literature. The first is the increased risk of villous adenoma malignant transformation, especially where rarely located, such as in the gastric site. The other depends upon the variety of villous adenoma symptomatology. The effects of low plasmatic protein levels are prominent in this case, but clinical manifestations range form insidious signs of occult bleeding, to frank diarrhea and/or rectal bleeding, up to unusual cases of secretory diarrhea with profound dehydration and hypokalemia or malabsorption.