Carotid intimal medial thickness in children and young adolescents with nephrotic syndrome

ABSTRACT

Patients with nephrotic syndrome [NS] are assumed to be at increased risk for atherosclerosis and coronary heart diseases [CHD], probably because of NS associated with hyperlipidemia, hypertension and steroid therapy. This study was aimed at evaluation of the carotid intimal thickness as a predictor of developing atherosclerosis in children and young adolescents with nephritic syndrome. Twenty-five children and young adolescents attending the pediatric nephrology outpatient clinic of El- Minia university hospital were enrolled in this study. They were 16 males and 9 females. Their age range between 8 and 14 years with a mean of 11 +/- 2.1 years. They were subdivided into 2 subgroups; one included 15 patients [60%] having proteinuria and not responding to steroid therapy and the other included 10patients [40%] having proteinuria and responding to steroid therapy. Fifteen healthy age and sex matched young adolescent served as a control group. All patients were subjected to thorough history taking and clinical examination. All subjects in the study underwent laboratory investigations including urinalysis, 24-hour protein in urine, serum creatinine, Triglycerides [TGs], cholesterol, low and high density lipoproteins [LDL and HDL], as well as carotid duplex. The results showed that carotid intimal thickness was significantly higher in nephritic patients than the results showed that carotid intimal thickness was significantly higher in nephritic patients than controls [p<0.001]. Serum LDL and cholesterol were significantly higher in nephritic patients than controls [p<0.01, p<0.02 respectively]. Carotid intimal thickness was directly correlated to relapse rates and serum HDL, LDL and cholesterol [p<0.001 for each]. Nephrotic patients with long duration of illness. Resistant to steroid therapy, have a history of hypertension and hyperlipidemia are more susceptible to early development of atherosclerosis and subsequent cardiovascular complications so they must be properly controlled especially early use of statins in children and young adolescent in those with high risk factors. Follow up of the high-risk nephrotic adolescent for possible development of CHD in young adulthood is recommended