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Subclinical cardiovascular disease and its association with risk factors in children with steroid-resistant nephrotic syndrome

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Abstract

Background

The aim of this study was to evaluate the presence of subclinical cardiovascular disease (CVD) and its relation to risk factors in pediatric patients with steroid-resistant nephrotic syndrome (NS).

Methods

Thirty-seven patients with normal renal function were compared with 22 healthy controls regarding the presence of subclinical CVD. Measurements included aortic pulse wave velocity (PWV), carotid intima media thickness (IMT), and left ventricular mass (LVM). Patients were additionally assessed for blood pressure (BP) pattern and the presence of hypertension by 24-h ambulatory blood pressure monitoring.

Results

Compared with the controls, patients had significantly higher mean aortic PWV-standard deviation scores (SDS), mean carotid IMT-SDS, and LVM index (p < 0.001 for all). Increased aortic PWV was noted in 5 % of patients, increased carotid IMT in 22 %, and increased LVM index in 19 %. Five patients (14 %) were hypertensive, and mean BP indexes, SDS, and BP loads during nighttime were significantly higher than those during daytime (p < 0.001 for all). Multivariate analysis revealed a significant relationship between PWV-SDS and ferritin (R 2 = 0.269, p = 0.006) and between carotid IMT-SDS and proteinuria (R 2 = 0.141, p = 0.022). The LVM index was independently associated only with higher body mass index SDS (R 2 = 0.317, p < 0.001). In addition, six patients (16 %) had multiple abnormal subclinical CVD markers, and increased subclinical CVD risk was independently associated only with higher low-density lipoprotein cholesterol (R 2 = 0.292, p = 0.044).

Conclusions

Based on these results, steroid-resistant NS children generally are at high risk of cardiovascular complications, but the increased risk is likely to be multifactorial.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Istanbul Medeniyet University and Göztepe Training and Research Hospital, 34750, Kadıköy, Istanbul, Turkey

    Cengiz Candan, Nurdan Yıldız & Pınar Turhan

  2. Department of Pediatric Nephrology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Nur Canpolat, Mehmet Taşdemir, Lale Sever & Salim Çalışkan

  3. Department of Pediatric Cardiology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Selman Gökalp

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  1. Cengiz Candan
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  2. Nur Canpolat
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Correspondence to Cengiz Candan.

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Candan, C., Canpolat, N., Gökalp, S. et al. Subclinical cardiovascular disease and its association with risk factors in children with steroid-resistant nephrotic syndrome. Pediatr Nephrol 29, 95–102 (2014). https://doi.org/10.1007/s00467-013-2608-3

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  • DOI: https://doi.org/10.1007/s00467-013-2608-3

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