Skip to main content
SpringerLink
Log in

Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

A total of 30 patients (ten female/20 male), 9 years to 22 years old (mean age 17.3 years) and 30 healthy teenage controls (mean age 16.4 years) were included in our study. The patients had steroid-sensitive idiopathic nephrotic syndrome (INS) and had completed steroid therapy 4 years to 15 years ago. Height and weight, body mass index (BMI), body composition, and intima-media thickness (IMT) were determined, as were levels of total cholesterol (TCh), low-density lipoprotein cholesterol (LDL-Ch), high-density lipoprotein cholesterol (HDL-Ch), triacylglycerols (TAGs), homocysteine (HCY), and high-sensitivity C-reactive protein (hsCRP). We did not observe any differences between the study and control groups in IMT (0.47 ± 0.1 vs 0.46 ± 0.1 mm) and body composition (fat tissue and water content). Differences in HDL-Ch and hsCRP levels between groups were not significant. In the study group we found significantly higher TCh levels (187.6 ± 57.2 mg/dl vs 158.8 ± 25.7 mg/dl; P = 0.012), LDL-Ch (115.9 ± 63.7 mg/dl vs 79.4 ± 25.4 mg/dl; P = 0.005), HCY (12.3 ± 7.7 µmol/l vs 7.6 ± 1.6 µmol/dl; P < 0.001), apolipoprotein B (ApoB) (113.6 ± 30.0 mg/dl vs 78.7 ± 13.6 mg/dl; P < 0.001) and ApoA1 (203.5 ± 50.8 mg/dl vs 156.5 ± 12.4 mg/dl; P < 0.001) levels. Multi-factor analysis of the influence of independent factors (number of recurrences, duration of remission, age, gender, and BMI) on the parameters under investigation indicated a positive correlation between IMT and the number of recurrences. Conclusions: 1. Patients treated for idiopathic nephrotic syndrome in the past should undergo regular laboratory tests of atherosclerosis risk factors, including not only cholesterol and its fractions, but also ApoA1, ApoB and HCY. 2. It is necessary to continue systematic check-ups of the intima-media thickness of the carotid arteries among young patients with anamnesis of INS, especially among patients who suffered from numerous relapses of this disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Orth SR, Ritz E (1998) The nephrotic syndrome. N Engl J Med 17:1202–1211

    Article  Google Scholar 

  2. Thabet MA, Salcedo JR, Chan JC (1993) Hyperlipidemia in childhood nephrotic syndrome. Pediatr Nephrol 7:559–566

    Article  CAS  Google Scholar 

  3. Radhakrishnan J, Appel AS, Valeri A, Appel GB (1993) The nephrotic syndrome, lipids and risk factors for cardiovascular disease. Am J Kidney Dis 22:135–142

    Article  CAS  Google Scholar 

  4. Mérouani A, Lévy E, Mongeau JG, Robitaille P, Lambert M, Delvin EE (2003) Hyperlipidemic profiles during remission in childhood idiopathic nephrotic syndrome. Clin Biochem 36:571–574

    Article  Google Scholar 

  5. Dogra GK, Herrmann S, Irish AB, Thomas MA, Watts GF (2002) Insulin resistance, dyslipidaemia, inflammation and endothelial function in nephrotic syndrome. Nephrol Dial Transplant 17:2220–2225

    Article  CAS  Google Scholar 

  6. Kuo K, Still R, Cale S, McDowell I (1997) Standardization (external and internal) of HPLC assay for plasma homocysteine. Clin Chem 43:1653–1655

    Article  CAS  Google Scholar 

  7. Minniti G, Piana A, Armani U, Cerone R (1998) Determination of plasma and serum homocysteine by high-performance liquid chromatography with fluorescence detection. J Chromatogr A 828:401–405

    Article  CAS  Google Scholar 

  8. Ruth EM, Kemper MJ, Leumann EP, Laube GF, Neuhaus TJ (2005) Children with steroid-sensitive nephrotic syndrome come of age: long-term outcome. J Pediatr 147:202–207

    Article  Google Scholar 

  9. Lewis MA, Baildom EM, Davis N, Houston IB, Postlethwaite RJ (1989) Nephrotic syndrome: from toddlers to twenties. Lancet 1:255–259

    Article  CAS  Google Scholar 

  10. Foster BJ, Shults J, Zemel BS, Leonard MB (2004) Interactions between growth and body composition in children treated with high-dose chronic glucocorticoids. Am J Clin Nutr 80:1334–1341

    Article  CAS  Google Scholar 

  11. Fakhouri F, Bocquet N, Taupin P, Presne C, Gagnadoux MF, Landais P, Lesavre P, Chauveau D, Knebelmann B, Broyer M, Grünfeld JP, Niaudet P (2003) Steroid-sensitive nephrotic syndrome: from childhood to adulthood. Am J Kidney Dis 41:550–557

    Article  Google Scholar 

  12. Adhikari M, Manikkam NE, Coovadia HM (1992) Effects of repeated courses of daily steroids and of persistent proteinuria on linear growth in children with nephrotic syndrome. Pediatr Nephrol 6:4–9

    Article  CAS  Google Scholar 

  13. Hung YT, Yang LY (2006) Follow-up of linear growth of body height in children with nephrotic syndrome. J Microbiol Immunol Infect 39:422–425

    PubMed  Google Scholar 

  14. Matsukura H, Inaba S, Shinozaki K, Yanagihara T, Hara M, Higuchi A, Takada T, Tanizawa T, Miyawaki T (2001) Influence of prolonged corticosteroid therapy on the outcome of steroid-responsive nephrotic syndrome. Am J Nephrol 21:362–367

    Article  CAS  Google Scholar 

  15. Kitamura M (1992) Growth retardation in children with frequent relapsing nephrotic syndrome on steroid-improvement of height velocity after administration of immunosuppressive agent. Nippon Jinzo Gakkai Shi 34:117–124

    CAS  PubMed  Google Scholar 

  16. Jabłońska J (2004) Distant effects of steroid therapy in the nephrotic syndrome of childhood. Ann Acad Med Stetin 50:17–27

    PubMed  Google Scholar 

  17. Drozdz D, Sancewicz-Pach K, Wierzchowska-Słowiaczek E (2000) Value of bioelectrical impedance analysis in the assessment of body water in children with nephrotic syndrome: initial results. Pol Merkuriusz Lek 8:224–225

    CAS  Google Scholar 

  18. Książek J, Niemirska A, Lipka M, Grenda R (2006) Evaluation of arterial intima-media thickness (IMT) in children with idiopathic nephrotic syndrome - preliminary report. Przegl Lek 63 [Suppl 3]:205–207

    PubMed  Google Scholar 

  19. Falaschi F, Ravelli A, Martignoni A, Migliavacca D, Sartori M, Pistorio A, Perani G, Martini A (2000) Nephrotic-range proteinuria, the major risk factor for early atherosclerosis in juvenile-onset systemic lupus erythematosus. Arthritis Rheum 43:1405–1409

    Article  CAS  Google Scholar 

  20. Woo KS, Chook P, Yu CW, Sung RYT, Qiao M, Leung SSF, Lam CWK, Metreweli C, Celermajer DS (2004) Effects of diet and exercise on obesity-related vascular dysfunction in children. Circulation 109:1981–1986

    Article  Google Scholar 

  21. Rodenburg J, Vissers MN, Wiegman A, van Trotsenburg ASP, van der Graaf A, de Groot E, Wijburg FA, Kastelein JJP, Hutten B (2007) Statin treatment in children with familial hypercholesterolemia: the younger, the better. Circulation 116:664–668

    Article  CAS  Google Scholar 

  22. Zilleruelo G, Hsia SL, Freundlich M, Gorman HM, Strauss J (1984) Persistence of serum lipid abnormalities in children with idiopathic nephrotic syndrome. J Pediatr 104:61–64

    Article  CAS  Google Scholar 

  23. Kuźma E, Roszkowska-Blaim M (2006) Lipids abnormalities in children with refractory nephrotic proteinuria. Przegl Lek 63 [Suppl 3]:201–204

    PubMed  Google Scholar 

  24. Pritchard PR (2000) Measurement and clinical significance of lecithin: cholesterol acyltransferase. In: Rifai N, Warnick GR, Dominiczak MH (eds) Handbook of lipoprotein testing, 2nd edn. AACC Press, Washington

    Google Scholar 

  25. Wasilewska A, Zoch-Zwierz W, Tobolczyk J, Tenderenda E (2007) High-sensitivity C-reactive protein (hs-CRP) level in children with nephrotic syndrome. Pediatr Nephrol 22:403–408

    Article  Google Scholar 

  26. Podda GM, Lussana F, Moroni G, Faioni EM, Lombardi R, Fontana G, Ponticelli C, Maioli C, Cattaneo M (2007) Abnormalities of homocysteine and B vitamins in the nephrotic syndrome. Thromb Res 120:647–652

    Article  CAS  Google Scholar 

  27. Joven J, Arcelús R, Camps J, Ordóñez-Llanos J, Vilella E, González-Sastre F, Blanco-Vaca F (2000) Determinants of plasma homocyst(e)ine in patients with nephrotic syndrome. J Mol Med 78:147–154

    Article  CAS  Google Scholar 

  28. Arnadottir M, Hultberg B, Berg AL (2001) Plasma total homocysteine concentration in nephrotic patients with idiopathic membranous nephropathy. Nephrol Dial Transplant 16:45–47

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics in Bytom, Medical University of Silesia, Katowice, Poland

    Maria H. Kniażewska, Anna K. Obuchowicz, Joanna Żmudzińska-Kitczak, Katarzyna Urban, Marta Marek & Jolanta Witanowska

  2. Department of Chemistry in Zabrze, Medical University of Silesia, Katowice, Poland

    Tomasz Wielkoszyński

  3. Department of Internal Diseases, Angiology and Physical Medicine, Medical University of Silesia, Katowice, Poland

    Karolina Sieroń-Stołtny

  4. Department of Pediatrics, Medical University of Silesia, Batorego 15 str., 41-902, Bytom, Poland

    Maria H. Kniażewska

Authors
  1. Maria H. Kniażewska
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna K. Obuchowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomasz Wielkoszyński
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joanna Żmudzińska-Kitczak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katarzyna Urban
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marta Marek
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jolanta Witanowska
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Karolina Sieroń-Stołtny
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria H. Kniażewska.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kniażewska, M.H., Obuchowicz, A.K., Wielkoszyński, T. et al. Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome. Pediatr Nephrol 24, 549–554 (2009). https://doi.org/10.1007/s00467-008-1029-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-008-1029-1

Keywords

Search

Navigation