Prevalence and determinants of peripheral arterial disease in children with nephrotic syndrome.

Peripheral arterial disease (PAD) is the least studied complication of nephrotic syndrome (NS). Risk factors which predispose children with NS to developing PAD include hyperlipidaemia, hypertension and prolonged use of steroids. The development of PAD significantly increases the morbidity and mortality associated with NS as such children are prone to sudden cardiac death. The ankle brachial index (ABI) is a tool that has been proven to have high specificity and sensitivity in detecting PAD even in asymptomatic individuals. We aimed to determine the prevalence of PAD in children with NS and to identify risk factors that can independently predict its development. A comparative cross-sectional study was conducted involving 200 subjects (100 with NS and 100 apparently healthy comparative subjects that were matched for age, sex and socioeconomic class). Systolic blood pressures were measured in all limbs using the pocket Doppler machine (Norton Doppler scan machine). ABI was calculated as a ratio of ankle to arm systolic blood pressure. PAD was defined as ABI less than 0.9. The prevalence of PAD was significantly higher in children with NS than matched comparison group (44.0% vs 6.0%, p < 0.001). Average values of waist and hip circumference were significantly higher in subjects with PAD than those without PAD (61.68± 9.1cm and 67.6± 11.2 cm vs 57.03 ± 8.3cm and 65.60± 12.5cm respectively, p< 0.005). Serum lipids (triglyceride, very low density lipoprotein, total cholesterol and low density lipoprotein) were also significantly higher in subjects with PAD than those without PAD [106.65mg/dl (67.8-136.7) vs 45.72mg/dl (37.7-61.3), 21.33mg/dl (13.6-27.3) vs 9.14mg/dl (7.5-12.3), 164.43mg/dl (136.1-259.6) vs 120.72mg/dl (111.1-142.1) and 93.29mg/dl (63.5-157.3) vs 61.84mg/dl (32.6-83.1), respectively p< 0.05]. Increasing duration since diagnosis of NS, having a steroid resistant NS and increasing cumulative steroid dose were independent predictors of PAD in children with NS; p< 0.05 respectively. With these findings, it is recommended that screening for PAD in children with NS should be done to prevent cardiovascular complications before they arise.

Is transcatheter closure superior to surgical ligation of patent ductus arteriosus among Nigerian Children?

BACKGROUND: Patent ductus arteriosus (PDA) is common among Nigerian children. It is the second only to ventricular septal defect among congenital heart diseases in Nigeria children. The study centers are the only centers in Nigeria which are able to offer both transcatheter closure of PDA and surgical ligation. The study aims to compare both methods in terms of the demographics of the individuals, cost and outcome. PATIENTS AND METHODS: Prospective, cross-sectional involving consecutive individuals who had either transcatheter closure or surgical ligation of PDA from June 2010 to January 2014. Individuals were grouped according to the method of closure of their defect. Data on their demographics, size of the defects, cost of treatment and outcome were compared for the two groups. The analysis was done using Microsoft Excel statistical software supplemented by Statistical Package for Social Sciences version 20.0. P < 0.05 was considered statistically significant. RESULTS: A total number of 28 individuals had either surgical ligation or device closure of PDA done at the studied period. The mean age of all the individuals was 4.58 ± 4.20 years with a median age of 3 years. The mean age of individuals that had surgical ligation was 3.40 ± 0.92 years and mean age of those who had transcatheter device closure was 6.69 ± 1.05 years (P = 0.677). Male to female ratio in both groups were 0.4:1. No mortality was recorded in both groups. However, 6 (21.4%) of the surgical patients and 1 (3.57%) of the patient with device closure had complications. The direct cost of the procedure for each of the patient who had device closure of PDA was about $3000 whereas the cost of surgical closure was about $1000. The indirect cost for device closure was about $100 while that of surgical closure was about $5000. CONCLUSION: Device closure of PDA has lesser risk of complications compared to surgical ligation. Its indirect cost is also cheaper. There is a need for availability and accessibility to device closure of PDA in our environment.