Hyperlipidemia in childhood idiopathic nephrotic syndrome during initial remission and relapse

The objective of this study was to correlate hyperlipidemia during initial remission of nephrotic child with relapse. This observational prospective study was carried out among 26 children, between 1 to 8 years age with first attack idiopathic nephrotic syndrome, who was seen at Paediatric Nephrology Department of BSMMU and Paediatric Nephrology Department, NIKDU, from December'2005 to August'2006 and were followed-up for at least 6 months after initial attack. Twenty two age and sex matched hospitalized children, suffering from non-renal diseases, were enrolled as controls. Fasting blood samples for lipid profile were taken at the time of diagnosis of both cases and controls and also during remission of cases only. These patients were divided into two groups based on serum lipid profile during remission. Group-I consisted 16 patients who had normal lipid profile during remission and Group-II consisted 10 patients who had abnormal lipid profile during remission. Both Groups I & II had higher mean levels of serum cholesterol, LDL, TG and Lp(a) than those of controls during initial diagnosis. Between two groups on remission, Group-II patients showed higher mean serum cholesterol (332.9±105.19 mg/dL vs. 183.13±16.89 mg/dL; p<0.001), serum LDL (252±101.67 mg/dL vs. 119.19±21.33mg/dL; p<0.001), and serum TG (182.8±73.83 mg/dL vs. 93.31±20.95 mg/dL; p<0.001). Five patients out of 10 patients of Group-II (19% of total case) developed subsequent relapse within 6 months follow-up. Among the relapsers, mean cholesterol (334±46 vs. 232±34 mg/dL; p<0.05) was significantly higher than that of non-relapsers of Group-II patients. On the other hand, no patient of Group-I developed relapse within 6 months follow-up. It may be concluded from this study that hyperlipidemia in general at remission, specifically serum total cholesterol, may be regarded as predictor of relapse in childhood idiopathic nephrotic syndrome.