Aortic Stiffening in Children with Nephrotic Syndrome

Early aortic stiffening was detected in children with nephrotic syndrome, indicating subclinical cardiovascular risk even during remission.M-mode echocardiography proved to be a simple, reliable, and child-friendly method for assessing vascular stiffness in clinical settings.Vascular stiffness correlated with renal function and body indices, linking kidney health to early cardiovascular alterations in NS.

Nephrotic syndrome (NS) in children is a chronic glomerular disorder that, beyond its renal implications, poses a significant risk for cardiovascular complications. Early vascular alterations, such as increased aortic stiffness, may signal subclinical cardiovascular dysfunction with long-term consequences.

This study aimed to evaluate aortic stiffness in children with idiopathic NS compared with age and sex-matched healthy controls using noninvasive echocardiographic indices.

A case-control study was conducted at Ali Asghar Pediatric Hospital from 2023 through 2024. Eighty-seven children with idiopathic NS and 87 healthy controls underwent M-mode echocardiographic assessment of the ascending aorta. Aortic systolic and diastolic diameters, along with systolic and diastolic blood pressure (SBP and DBP, respectively), were used to calculate stiffness indices: aortic strain, distensibility, stiffness index β, and pressure-strain elastic modulus (PSEM). Data were analyzed using SPSS version 23 (IBM), and a P value below 0.05 was considered statistically significant for all analyses.

Children with NS had significantly higher SBP and DBP, reduced aortic strain (9.62% vs 14.77%), decreased aortic distensibility (0.0050 vs 0.0085), and elevated stiffness index β and PSEM values (P<0.001 for all). No significant sex distribution differences were noted. Responders to treatment showed better renal function and lower BP but did not differ significantly in vascular stiffness measures. Positive correlations were found between stiffness parameters and proteinuria, serum creatinine, and anthropometric indices.

Children with NS exhibited early signs of aortic stiffening, even during clinical remission. These findings support the incorporation of cardiovascular surveillance into the long-term management of NS to identify at-risk children and initiate early interventions.