ESPN 50th Annual Meeting

ESPN 2017


 
Risk Factors for Cardiovascular Comorbidities in Children with Steroid-Sensitive and Steroid-Resistant Nephrotic Syndrome
FEHIME K. EROGLU 1 REZAN TOPALOGLU 1 TEVFIK KARAGOZ 2 BERNA OGUZ 3 FATIH OZALTIN 1 BORA GULHAN 1 ALI DUZOVA 1

1- HACETTEPE UNIVERSITY FACULTY OF MEDICINE, DIVISION OF PEDIATRIC NEPHROLOGY, ANKARA, TURKEY
2- HACETTEPE UNIVERSITY FACULTY OF MEDICINE, DIVISION OF PEDIATRIC CARDIOLOGY, ANKARA, TURKEY
3- HACETTEPE UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF RADIOLOGY
 
Introduction:

The aim of this study is to evaluate cardiovascular (CV) comorbidities and endothelial dysfunction markers and to define risk factors in children with idiopathic nephrotic syndrome (INS) and eGFR >60 ml/min/1.73m2.

Material and methods:

Forty-nine children (19 girls, 30 boys; 5.04±3.68 years) were included in this study. Patients were categorized as steroid sensitive (SSNS; 63%) and steroid resistant (SRNS; 36%) according to definition of KDIGO. Aortic pulse wave velocity (PWV), carotid intima media thickness (cIMT), left ventricular mass (LVM) and ambulatory blood pressure measurements (ABPM) were done; and standard deviation scores (SDS) according to age and height were correlated with anthropometric, cumulative drug dosage, clinical and laboratory parameters including urine protein measures, lipid profile, von-Willebrand factor and sUPAR levels.

Results:

 Only 13% and 14% had high PWV-SDS and MAP-SDS, respectively; but 73.9% of patients had high cIMT-SDS, 80% had left ventricular hypertrophy (LVH). There were no significant differences between SRNS and SSNS patients for in CVC parameters. BMI-z score was significantly correlated with PWV-SDS (height), mean 24-hour arterial pressure (MAP)-SDS (height and age) and LVMI. Corticosteroid exposure for the last 12 months was significantly correlated with cIMT-SDS (age; r: 0.39, p 0.007) and LVMI (r: 0.33, p 0.036). Current cyclosporine dose was significantly correlated PWV-SDS (age), MAP-SDS (age). cIMT-SDS was also significantly correlated with mean platelet volume (r: -0.425, p 0.003). Among patients with LVH 86.2% and 86.7% had normal MAP-SDS and PWV-SDS, respectively. Multivariate analysis revealed high dose corticosteroid exposure for the last 12 months (>35 mg/kg) as the independent risk factor for LVH (RR: 11.02; 95% CI: 1.02-119.49; p <0.05). Serum sUPAR level was correlated MAP-SDS (height) (r: 0.298; p 0.056). vWF level was higher in patients who had more than one CV-abnormality (84.6±39.4% vs.59.7 ±24.0% p 0.08).

Conclusions:

In this cohort, SRNS and SSNS groups were comparable for CV comorbidities. There were associations between CV abnormality and exposure to corticosteroids and cyclosporine for the last 12 months rather than cumulative drug doses and 24-hour mean arterial pressure.