| Objective: Hyperlipidemia is one of the primary features of the nephrotic syndrome. Some studies have reported hyperlipidemia not only contributes to accelerated atherosclerosis in nephrotic syndrome patients but also enhances the progression of glomerular injury. Several kinds of lipid-lowering agents have been used to alleviate the hyperlipidemia. The aim of this systematic review was to evaluate the benefits and harms of lipid-lowering agents in primary nephrotic syndrome patients.Method: We searched the Cochrane Library, MEDLINE, EMBASE, CBM, and some Chinese journals and books. Selection criteria: Randomized controlled trials comparing different lipid-lowering agents with placebo or other current treatment regimens in primary nephrotic syndrome. Two reviewers independently assessed trial quality and extracted data. We resolved the disagreements in consultation with the expert. Results: The combined search of Cochrane Library, MEDLINE, EMBASE and CBM identified 383 articles. There were 127 articles forantihyperlipidemia treatment in nephrotic syndrome patients and 14 trials involving 529 people were eligible according to the inclusion criterion. Meta-analysis of these trials showed that hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) can reduce the serum lipid levels of Chloesterol, Triglyceride and Low density lipoprotein, reduce the excretion of protein in urine, and increase serum albumin level. Compared unsaturated fatty acid (Max EPA) and Fibrates (Gemfibrozil) plus routine therapy with routine therapy, there was no difference between two groups in Cholesterol, Triglyceride, LDL and HDL concentration.Reviewers' conclusions: HMG-CoA reductase inhibitors appears to have more effect on reducing serum Cholesterol, Triglyceride, LDL, proteinuria and increasing serum albumin. And lipid-lowering agents can improve the symptom and protect renal function. Therefore statins maybe the most effect drugs for lowering lipids in primary nephrotic syndrome.
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