Background: It has been suggested that hyperlipidemia contributes to the progression of kidney disease and there are some experimental reports that support the hypothesis of lipid nephrotoxicity. The treatment of hyperlipidemia in patients with renal disease has two purposes: to prevent the development of cardiovascular disease and to prevent the progression of renal disease. However, statins, which are widely used to treat hyperlipidemia, should be used very carefully in patients with renal disease, especially in those whose serum creatinine level is more than 3mg/dL. Atorvastatin, an HMG-CoA reductase inhibitor, is completely metabolized in the liver. Thus, we thought that atorvastatin could be used safely in hyperlipidemic patients with chronic renal disease.
Patients and methods: Atorvastatin was administered to 84 hyperlipidemic patients with chronic renal disease (including dialysis patients) for 12 months. TC, TG, LDL-C, AST, ALT, CK, BUN, and Cr were measured at 3, 6, and 12 months during treatment. Blood pressure and renal function, as indicated by urinary protein excretion and creatinine clearance measured at 0 and 12 months during treatment, were also monitored.
Results: TC and LDL-C were decreased at every determination point regardless of the kidney function, which was not affected by atorvastatin. Urinary protein excretion (UP) decreased significantly during the study period in patients who had not taken any anti-hyperlipidemic drug before treatment with atorvastatin. This decrease in UP was not associated with significant Ccr change. However, the decrease in UP was not statistically significant in all the patients. The decrease in UP showed a significant positive correlation with the decrease in TC and of the mean BP. Conclusion: Atorvastatin can be used safely in hyperlipidemic patients with chronic renal disease including dialysis patients under periodical monitoring. Atorvastatin could contribute to prevent the progression of renal disease.

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Henoch-Schönlein purpura (HSP) is a systemic vasculitis and characterized by the tissue deposition of IgA-containing immune complexes. A 50-year-old man with end-stage renal failure due to diabetic nephropathy on maintenance hemodialysis, presented purpura, hematuria, abdominal pain, and joint pain. He also presented a high fever with neutrophilia. Biopsy of skin lesions revealed inflammation of the small vessel accompanied by vascular IgA deposition. Based on the clinical symptoms and skin biopsy, we made the diagnosis of HSP. Oral prednisolone was administered resulting in an improvement of the clinical symptoms.
A skin biopsy should be performed for histological and immunofluorescence studies in the case of clinical suspicion of HSP with end-stage renal disease on hemodialysis.

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A 76-year-old woman was admitted to our hospital because of pyrexia and fatigue. One year earlier, she was diagnosed as nephrotic syndrome (NS) caused by focal segmental glomerulosclerosis and immunosuppressive therapy was started with marked amelioration of proteinuria. Thereafter, her renal function worsened, but only supportive treatment was continued. After admission, a cerebrospinal fluid (CSF) examination revealed Cryptococcus neoformans (C. neoformans) by india ink staining and a subsequent CSF culture confirmed C. neoformans infection. Accordingly, we made the diagnosis of cryptococcal meningitis and immediately started multiple anti-fungal drugs with dosage-modification according to her impaired renal function. Immunosuppressive therapy for NS was temporarily terminated. The inflammatory signs and symptoms soon were markedly improved, but the anti-cryptococcal antibody titer in the serum and CSF remained high. Immunosuppressive therapy was started again at a low dosage because urinary protein had increased again. One hundred and eight days from admission, she was discharged with a regimen of multiple anti-fungal drugs. Proteinuria and renal insufficiency was almost stable during hospitalization.
Most fungal infection develops in patients in an immunosuppressive state induced by immunosuppressive drugs, HIV infection and so on. Patients with NS are frequently in an Immunosuppressive state because of urinary loss of immunoglobulins and the use of immunosuppressive drugs. Therefore, it should be remembered that patients with NS are at a high risk of suffering from fungal infection.

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