{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:22Z","timestamp":1753876162850,"version":"3.41.2"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Nephrotic syndrome causes severe hypercholesterolaemia due to increased production and altered clearance of lipoproteins from the liver. It is challenging for patients with nephrotic syndrome and coronary heart disease to meet LDL-cholesterol (LDL-C) goals for secondary prevention with conventional lipid-lowering therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We present a man with nephrotic syndrome caused by focal segmental glomerular sclerosis (FSGS) and hypercholesterolaemia. He presented at the emergency room (ER) with an ST-elevation myocardial infarction at the age of 26. On follow-up, the patient had persistent hypercholesterolaemia [LDL-C 3.9\u2009mmol\/L and lipoprotein(a) 308\u2009nmol\/L] despite a combination of lipid-lowering therapy with atorvastatin 80\u2009mg\/day and ezetimibe 10\u2009mg\/day. Addition of the proprotein convertase subtilisin\/kexin type 9 (PCSK9) inhibitory antibody evolocumab 140\u2009mg bi-monthly did not improve cholesterol levels. However, after addition of the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin 10\u2009mg\/day on top of other anti-proteinuric treatments, the patient\u2019s proteinuria was reduced and a dramatic drop in LDL-C level by 3.2\u20130.6\u2009mmol\/L (\u221281%) was observed when evolocumab was re-introduced.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>We show that target LDL-C levels were obtained in this patient with therapy-resistant FSGS and hypercholesterolaemia following multi-pharmacological treatment with SGLT2 and PCSK9 inhibitors on top of conventional lipid-lowering therapy. The SGLT2-inhibitor reduced proteinuria and, speculatively, also reduced urinary loss of PCSK9-antibody. Therefore, in patients with nephrotic syndrome and cardiovascular disease novel therapeutic options to manage proteinuria could be considered to improve the efficacy of the lipid-lowering therapy, especially when the protein-based PCSK9 inhibitors are used.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab151","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T09:06:54Z","timestamp":1620896814000},"source":"Crossref","is-referenced-by-count":5,"title":["Effective cholesterol lowering after myocardial infarction in patients with nephrotic syndrome may require a multi-pharmacological approach: a case report"],"prefix":"10.1093","volume":"5","author":[{"given":"Simon","family":"Sjuls","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Karolinska University Hospital Huddinge, Stockholm 141 86, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulf","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, S\u00f6dersjukhuset, Stockholm 118 83, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4597-9369","authenticated-orcid":false,"given":"Karin","family":"Littmann","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Karolinska University Hospital Huddinge, Stockholm 141 86, Sweden"},{"name":"Department of Medicine H7, Karolinska Institutet, Stockholm 141 86, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9752-9941","authenticated-orcid":false,"given":"Annette","family":"Bruchfeld","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University, Link\u00f6ping 581 83, Sweden"},{"name":"Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institute, Stockholm 141 86, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1230-6205","authenticated-orcid":false,"given":"Jonas","family":"Brinck","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Karolinska University Hospital Huddinge, Stockholm 141 86, Sweden"},{"name":"Department of Medicine H7, Karolinska Institutet, Stockholm 141 86, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"2021070816562191600_ytab151-B1","first-page":"57","article-title":"Dyslipidaemia in nephrotic syndrome: mechanisms and treatment","volume":"14","author":"Agrawal","year":"2018","journal-title":"Nat Rev"},{"key":"2021070816562191600_ytab151-B2","doi-asserted-by":"crossref","first-page":"513","DOI":"10.2215\/CJN.10131011","article-title":"Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease","volume":"7","author":"Kerlin","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"2021070816562191600_ytab151-B3","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1093\/ndt\/gfz108","article-title":"Protein convertase subtilisin\/kexin type 9 biology in nephrotic syndrome: implications for use as therapy","volume":"35","author":"Busuioc","year":"2020","journal-title":"Nephrol Dial Transplant"},{"key":"2021070816562191600_ytab151-B4","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1042\/CS20171298","article-title":"SGLT2 inhibition and kidney protection","volume":"132","author":"Nespoux","year":"2018","journal-title":"Clin Sci"},{"key":"2021070816562191600_ytab151-B5","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1056\/NEJMoa2024816","article-title":"Dapagliflozin in patients with chronic kidney disease","volume":"383","author":"Heerspink","year":"2020","journal-title":"N Engl J Med"},{"year":"2021","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. 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Possible risks of extremely low levels","volume":"281","author":"Olsson","year":"2017","journal-title":"J Intern Med"},{"key":"2021070816562191600_ytab151-B9","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1146\/annurev-physiol-031620-095920","article-title":"Effects of SGLT2 inhibitors on kidney and cardiovascular function","volume":"83","author":"Vallon","year":"2021","journal-title":"Annu Rev Physiol"},{"key":"2021070816562191600_ytab151-B10","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1007\/s00467-015-3120-8","article-title":"Pharmacokinetics of rituximab in a pediatric patient with therapy-resistant nephrotic syndrome","volume":"30","author":"Counsilman","year":"2015","journal-title":"Pediatr Nephrol"},{"key":"2021070816562191600_ytab151-B11","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/s12882-017-0644-0","article-title":"Successful treatment of a patient with refractory nephrotic syndrome with PCSK9 inhibitors: a case report","volume":"18","author":"Awanami","year":"2017","journal-title":"BMC Nephrol"},{"key":"2021070816562191600_ytab151-B12","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.21037\/apm-19-587","article-title":"Treatment of hyperlipidemia with proprotein convertase subtilisin\/kexin type 9 inhibitor in a patient with nephrotic syndrome: a case report","volume":"9","author":"Choi","year":"2020","journal-title":"Ann Palliat Med"},{"key":"2021070816562191600_ytab151-B13","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.metabol.2015.10.031","article-title":"Distinct metabolism of apolipoproteins (a) and B-100 within plasma lipoprotein(a)","volume":"65","author":"Diffenderfer","year":"2016","journal-title":"Metabolism"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/5\/ytab151\/37929711\/ytab151.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/5\/ytab151\/37929711\/ytab151.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:56:36Z","timestamp":1625792196000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytab151\/6275013"}},"subtitle":[],"editor":[{"given":"Panagiotis","family":"Xaplanteris","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Callum","family":"Little","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Maria","family":"Mattioli","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Sarandeep Kaur","family":"Marwaha","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Carlos Minguito","family":"Carazo","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytab151","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2021,5,1]]},"published":{"date-parts":[[2021,5,1]]},"article-number":"ytab151"}}