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Published on: June 16, 2014
Endothelial Dysfunction in Children With Nephrotic Syndrome: A Cross-Sectional Study
Harapriya Das1, Amit Satapathy1, Joseph John1
1Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, IND.
Insights
Children with nephrotic syndrome (NS) show persistent dyslipidemia during remission and a trend towards lower Reactive Hyperemia Index (RHI), indicating potential early vascular changes. Further studies are needed to confirm these findings in pediatric NS patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health
- Vascular Biology
Background:
- Children with nephrotic syndrome (NS) face increased cardiovascular risks.
- Limited research exists on arterial stiffness and endothelial function in pediatric NS.
- Identifying predictive risk factors for premature atherosclerosis in these children is crucial.
Purpose of the Study:
- To assess arterial stiffness and endothelial function in children with NS.
- To measure carotid intimal medial thickness (cIMT) and flow-mediated dilatation (FMD).
- To predict the risk of premature atherosclerosis in pediatric NS patients compared to controls.
Main Methods:
- Enrolled 33 children with NS in remission (ages 2-14) and 39 healthy controls.
- Collected patient history, conducted physical examinations, and performed anthropometric measurements.
- Measured cIMT, FMD, and other physiological parameters, including Reactive Hyperemia Index (RHI).
Main Results:
- Over 50% of children with NS exhibited dyslipidemia during remission.
- No significant differences were found in mean cIMT or FMD between NS patients and controls.
- A trend towards a lower RHI was observed in children with NS.
Conclusions:
- Dyslipidemia is prevalent in children with nephrotic syndrome even in remission.
- While cIMT and FMD showed no significant differences, RHI was notably lower in the NS group.
- These findings suggest potential subclinical vascular alterations in pediatric NS, warranting further investigation.
Abstract:
Background Children with nephrotic syndrome (NS) have a higher risk of cardiovascular morbidity. Studies on the evaluation of arterial stiffness and endothelial function and its predictive risk factors in these children are limited. Objective The primary objective of the study was to determine arterial stiffness by measuring carotid intimal medial thickness, flow-mediated dilatation, and physiological parameters in children with nephrotic syndrome to predict the risk of premature atherosclerosis as compared to controls. Participants A total number of 33 children with NS in the age group of 2-14 years in remission and 39 healthy controls were enrolled in the study. Out of 33 children with nephrotic syndrome, five were infrequently relapsing NS, eight were frequently relapsing, 16 were steroid dependent, and four were steroid-resistant NS. Intervention Relevant history, physical examination, anthropometric measurements, and laboratory investigations were done. Carotid intimal medial thickness (cIMT), flow-mediated dilatation (FMD), and other physiological parameters were measured in both children with NS and control groups. Outcome Carotid intimal medial thickness (cIMT), flow-mediated dilatation (FMD), and other physiological parameters were compared between children with NS and healthy controls for detecting arterial stiffness and endothelial dysfunction. Results Dyslipidaemia was seen in more than 50% of children during remission. There was neither significant difference in mean cIMT in the common carotid artery nor FMD between the control and study groups. There was a trend of lower Reactive Hyperemia Index (RHI) in children with NS. Conclusion Dyslipidemia persists even during the remission phase in NS. No statistically significant difference is observed in cIMT and percentage proportionate change in FMD in both the study and control groups. Nevertheless, RHI is notably lower in children with NS. These findings need further validation in future studies.
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