Cardiac evaluation in children with problematic nephrotic syndrome

ABSTRACT

Hyperlipidemia, an important characteristic of nephrotic syndrome [NS] in children, is usually observed during the active phase of the disease and disappears with resolution of proteinuria. However, persistent lipid abnormalities have been reported and raised the question of development of atherosclerosis. This study was designed to elaborate the risk factors for developing atherosclerotic cardiovascular disease in patient with problematic NS. The study was conducted on 30 patients with primary NS from the nephrology clinic of Alexandria University Children's Hospital over one year duration. They were classified into 3 groups group I included 20 patients with problematic NS [i.e. steroid resistant, steroid dependent or frequent relapsers], group II including 10 patients with minimal change NS in remission, and group Ill [control group] of 10 apparently healthy age and sex matched children. For all patients complete urine analysis, 24 hour urinary protein excretion, serum total proteins and albumin, serum urea and creatinine, creatinine clearance, complete lipid profile, plasma oxidized LDL [oxLDL] using ELISA technique, cardiac enzymes [creatine phosphokinase, myocardial isoenzyme, as partate amino transferase and lactate dehydrogenase], and serum complement 3 [C3] were quantified. Also detailed echocardiography, 12-lead ECG, and chest X-ray were done. Both systolic and diastolic blood pressures were significantly higher in group I when compared with group Ill [P= 0.02 and P =0.008 respectively]. Group I had significantly higher levels of triglycerides [TG], total cholesterol, low density lipoprotein [LDL] and very low density lipoprotein [VLDL] when compared with the other two groups [P=0.003, 0.001, 0.0002 and 0.02 respectively]. The mean value for oxLDL was significantly higher in group I when compared with group II and III. There was no significant difference in the level of high density lipoprotein [HDL] among the three groups. Also it was significantly higher in group II when compared with group III [P=0.002]. The mean value for the interventricular septal thickness in diastole [IVSd] and left ventricular posterior wall thickness in diastole [LVPWd] was higher in groups I and II in comparison with group Ill [P=0.02 and P=0.04 respectively]. In conclusion, Children with problematic nephrotic syndrome are at risk of developing atherosclerotic cardiovascular disease as result of systemic hypertension, increased LV mass, persistent significant elevation of levels of cholesterol, TG, LDL and ox-LDL with normal level of HDL