与不频繁复发型肾病综合征患儿高血压及心血管参数相关的因素。

Factors Associated With Hypertension and Cardiovascular Parameters in Children With Infrequently Relapsing Nephrotic Syndrome.

机构信息

Division of Pediatric Nephrology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi.

Division of Pediatric Nephrology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi. Correspondence to: Prof Abhijeet Saha, Division of Pediatric Nephrology, Room no 102, Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital, New Delhi 110 001.

出版信息

Indian Pediatr. 2023 Jun 15;60(6):475-480. Epub 2023 Apr 20.

PMID:37211892

Abstract

OBJECTIVES

To assess the prevalence of hypertension in children with infrequently relapsing nephrotic syndrome (IRNS) and its association with dyslipidemia, and end organ damage including left ventricular hypertrophy (LVH), at relapse and after steroid induced remission.

METHODS

Prospective observational study conducted in 83 children aged 1-12 years with IRNS, presenting in relapse. Blood pressure, fundus examination, blood and urine investigations were done at relapse and then at 4 weeks of therapy. Echocardiography at 4 weeks was performed for assessment of LVH and relative wall thickness (RWT) for concentric geo-metry (CG).

RESULTS

27 patients (32.5%) developed hypertension, out of which 21 patients (25.3%) had stage I hypertension. Hypertension in first episode (63.0%, P<0.01) and in previous relapses (87.5%, P<0.001) was significantly associated with hypertension in the current episode. 12 patients had a positive family history of hypertension, of which 8 (66.7%) were classified under the hypertensive group (P=0.016). Concentric geometry (CG) was found in 28% of hypertensive and 5.5% of non-hypertensive children (P=0.011). On regression analysis, a lower Up:Uc at the time of relapse was found to have a protective role for development of hypertension.

CONCLUSION

One third children with IRNS had hypertension at relapse and a high proportion of hypertensive patients had CG pattern on echocardiography.

摘要

目的

评估复发频率较低的肾病综合征（IRNS）患儿的高血压患病率及其与血脂异常、终末器官损害（包括左心室肥厚 [LVH]）的关系，包括在复发时和类固醇诱导缓解后。

方法

对 83 名年龄在 1-12 岁的复发 IRNS 患儿进行前瞻性观察研究。在复发时进行血压、眼底检查、血液和尿液检查，然后在治疗 4 周时进行检查。在第 4 周进行超声心动图检查以评估 LVH 和相对壁厚度（RWT）用于评估同心几何形状（CG）。

结果

27 名患者（32.5%）出现高血压，其中 21 名患者（25.3%）为 I 期高血压。首次发作时（63.0%，P<0.01）和以前发作时（87.5%，P<0.001）的高血压与当前发作时的高血压显著相关。12 名患者有高血压家族史，其中 8 名（66.7%）被归类为高血压组（P=0.016）。在高血压患儿中发现 28%存在同心几何形状（CG），而非高血压患儿中为 5.5%（P=0.011）。回归分析发现，在复发时 Up:Uc 较低的患者发生高血压的保护作用。