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Incidence and Risk Factors for Hypertension among Children with Nephrotic Syndrome
Cal Robinson1, Stéphanie Wagner2, Nowrin Aman3
1Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
The Journal of Pediatrics
|December 22, 2024
Summary
Half of children with nephrotic syndrome develop hypertension. Steroid-resistant, steroid-dependent, frequently-relapsing, and obese children face the highest risks, necessitating close blood pressure monitoring.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Children
Background:
- Nephrotic syndrome is a significant kidney disorder in children.
- Hypertension is a known complication, but its incidence and specific risk factors in this population require further elucidation.
Purpose of the Study:
- To determine the incidence of hypertension in children with nephrotic syndrome.
- To identify risk factors associated with hypertension development in this cohort.
Main Methods:
- Prospective observational study using data from the Insight into Nephrotic Syndrome (INSIGHT) cohort.
- Hypertension defined by elevated blood pressure or anti-hypertensive medication initiation.
- Analysis stratified by steroid-resistance/sensitivity and relapse frequency.
Main Results:
- 53% of 748 children developed hypertension over a median follow-up of 5.2 years (incidence rate 8.2/100 person-years).
- Hypertension was more common in steroid-resistant (70% vs. 52%), steroid-dependent (67%), and frequently-relapsing (63%) nephrotic syndrome.
- Higher BMI Z-score and academic center were risk factors in steroid-sensitive cases.
Conclusions:
- Approximately half of children with nephrotic syndrome develop hypertension.
- Steroid-resistance, steroid-dependency, frequent relapses, and obesity are key risk factors.
- Regular blood pressure monitoring is crucial for early detection and management.
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