Dowerah Pritikar, Gogoi Arpita, Shira Caroline D, Sarkar Bikash, Mazumdar Sarada
Pediatrics and Neonatology, Assam Medical College & Hospital, Dibrugarh, IND.
Cureus. 2023 Oct 21;15(10):e47434. doi: 10.7759/cureus.47434. eCollection 2023 Oct.
Nephrotic syndrome in children is characterized by dyslipidemia, which is an indirect risk factor for cardiovascular diseases, progressive glomerulosclerosis, and related complications. The objective is to determine the range of lipid profile abnormalities in relation to onset, relapse, and remission, as well as to determine if there is any relationship between dyslipidemia and the frequency of relapses.
One hundred and two diagnosed cases of nephrotic syndrome in the age group of less than 12 years were included, out of which 64 patients belonged to the first episode of nephrotic syndrome and 38 patients were relapse cases. Steroid-resistant nephrotic syndrome cases or patients with a history of diabetes mellitus, hypothyroidism, familial hypercholesterolemia, children with chronic kidney disease, and edema due to other causes were excluded from the study.
There was a statistically significant increase in lipid parameters except for high-density lipoprotein (HDL) cholesterol at the disease onset when compared to remission in cases of the first episode as well as relapse cases of nephrotic syndrome. There was a positive correlation between relapse frequency and dyslipidemia. Dyslipidaemia was also associated with low serum albumin, with a p-value <0.001, which is statistically significant.
Dyslipidemia is significantly higher in relapse cases of nephrotic syndrome and remains higher even during remission. Dyslipidemia is a directly associated risk factor for atherosclerosis and coronary heart disease (CAD), along with progressive glomerulosclerosis. Early identification and treatment of hyperlipidemia is therefore justified so that along with longevity, we can also improve the quality of life of children suffering from nephrotic syndrome.
儿童肾病综合征的特征是血脂异常，这是心血管疾病、进行性肾小球硬化及相关并发症的间接危险因素。目的是确定血脂谱异常在疾病发作、复发和缓解期的范围，以及确定血脂异常与复发频率之间是否存在关联。
纳入102例12岁以下确诊的肾病综合征病例，其中64例为肾病综合征初发患者，38例为复发患者。研究排除了激素抵抗型肾病综合征病例或有糖尿病、甲状腺功能减退、家族性高胆固醇血症病史的患者、慢性肾脏病患儿以及其他原因导致水肿的患者。
与肾病综合征初发及复发病例缓解期相比，疾病发作时除高密度脂蛋白（HDL）胆固醇外，其他血脂参数均有统计学意义的升高。复发频率与血脂异常呈正相关。血脂异常还与低血清白蛋白相关，p值<0.001，具有统计学意义。
肾病综合征复发病例的血脂异常明显更高，即使在缓解期也仍然较高。血脂异常是动脉粥样硬化和冠心病（CAD）以及进行性肾小球硬化的直接相关危险因素。因此，早期识别和治疗高脂血症是合理的，这样除了延长寿命外，我们还可以提高肾病综合征患儿的生活质量。
