Hypertension and its severity in children with steroid sensitive nephrotic syndrome during remission

Keshri, Swasti; Sharma, Shobha; Agrawal, Neha; Guilliani, B P; Aggrawal, Kailash Chandra

doi:10.1007/s10157-018-1565-3

Cited by 7 publications

(6 citation statements)

References 19 publications

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Section: Management Of Severe Edemamentioning

confidence: 99%

“…The reported prevalence of hypertension in childhood SSNS is variable between 7 and 34% [195][196][197][198][199][200]. It occurs in children with SDNS and FRNS [200] and also in children in remission and/or 1-10 years off medication [196], especially in case of positive family history [195,196]. The etiology is multifactorial and includes medication side effects, in particular gluco-corticoids and CNIs, and fluid overload due to inappropriate use of albumin infusion during relapses.…”

Section: Management Of Severe Edemamentioning

confidence: 99%

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IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

Trautmann

Boyer²,

Hodson³

et al. 2022

Pediatr Nephrol

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Idiopathic nephrotic syndrome is the most frequent pediatric glomerular disease, affecting from 1.15 to 16.9 per 100,000 children per year globally. It is characterized by massive proteinuria, hypoalbuminemia, and/or concomitant edema. Approximately 85–90% of patients attain complete remission of proteinuria within 4–6 weeks of treatment with glucocorticoids, and therefore, have steroid-sensitive nephrotic syndrome (SSNS). Among those patients who are steroid sensitive, 70–80% will have at least one relapse during follow-up, and up to 50% of these patients will experience frequent relapses or become dependent on glucocorticoids to maintain remission. The dose and duration of steroid treatment to prolong time between relapses remains a subject of much debate, and patients continue to experience a high prevalence of steroid-related morbidity. Various steroid-sparing immunosuppressive drugs have been used in clinical practice; however, there is marked practice variation in the selection of these drugs and timing of their introduction during the course of the disease. Therefore, international evidence-based clinical practice recommendations (CPRs) are needed to guide clinical practice and reduce practice variation. The International Pediatric Nephrology Association (IPNA) convened a team of experts including pediatric nephrologists, an adult nephrologist, and a patient representative to develop comprehensive CPRs on the diagnosis and management of SSNS in children. After performing a systematic literature review on 12 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, recommendations were formulated and formally graded at several virtual consensus meetings. New definitions for treatment outcomes to help guide change of therapy and recommendations for important research questions are given.

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Section: Management Of Severe Edemamentioning

confidence: 99%

Section: Management Of Severe Edemamentioning

confidence: 99%

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

Trautmann

Boyer²,

Hodson³

et al. 2022

Pediatr Nephrol

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“…Of those, 73% had a positive family history of HTN compared to 32% in the normotensive group. BP was significantly correlated with serum cholesterol and LDL levels (10).…”

Section: Epidemiologymentioning

confidence: 99%

Hypertension in Childhood Nephrotic Syndrome

Shatat

Becton²,

Woroniecki

2019

Front. Pediatr.

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Arterial hypertension (HTN) is commonly encountered by clinicians treating children with steroid sensitive (SSNS) and steroid resistant nephrotic syndrome (SRNS). Although the prevalence of HTN in SSNS is less documented than in SRNS, recent studies reported high prevalence in both. Studies have estimated the prevalence of HTN in different patient populations with NS to range from 8 to 59.1%. Ambulatory HTN, abnormalities in BP circadian rhythm, and measures of BP variability are prevalent in patients with NS. Multiple mechanisms and co-morbidities contribute to the pathophysiology of HTN in children with NS. Some contributing factors are known to cause acute and episodic elevations in blood pressure such as fluid shifts, sodium retention, and medication side effects (steroids, CNIs). Others are associated with chronic and more sustained HTN such as renal fibrosis, decreased GFR, and progression of chronic kidney disease. Children with NS are more likely to suffer from other cardiovascular disease risk factors, such as obesity, increased measures of arterial stiffness [increased carotid intima-media thickness (cIMT), endothelial dysfunction, increased pulse wave velocity (PWV)], impaired glucose metabolism, dyslipidemia, left ventricular hypertrophy (LVH), left ventricular dysfunction, and atherosclerosis. Those risk factors have been associated with premature death in adults. In this review on HTN in patients with NS, we will discuss the epidemiology and pathophysiology of hypertension in patients with NS, as well as management aspects of HTN in children with NS.

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“…Previous studies have identified, and attempted to characterize, hypertension in both pediatric and adult patients with NS. [2][3][4]8,9 Cameron et al noted significantly elevated BP measurements in 31% of patients older than 15 years of age in their study of minimal change disease, 10 and this seemed to coincide with the proteinuric state. In addition, between 10% and 30% of pediatric patients with steroid-resistant NS, or genetic forms of NS, were hypertensive on presentation on analysis of the PodoNet registry data.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, they may develop increased arterial blood pressure (BP) throughout the course of NS. 2 , 3 , 4 Blood pressure lability has been observed in these cohorts of pediatric patients with variable degrees of proteinuria; however, the impact of proteinuria on BP is not fully elucidated. 2 , 3 , 4 Clarifying this further may impact therapeutic approaches for hypertension in patients with proteinuria, even if it is only transient.…”

Section: Introductionmentioning

confidence: 99%

Diastolic hypertension is associated with proteinuria in pediatric patients

Myette

Burger

Geier

et al. 2021

Health Science Reports

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Background and Aims Blood pressure lability has been observed in certain cohorts of pediatric patients with variable degrees of proteinuria; however, the impact of proteinuria on blood pressure is not fully elucidated. The objective of our study was to analyze blood pressure and heart rate in pediatric patients with proteinuria. Methods We performed a retrospective chart review of patients (age 1‐18) diagnosed with idiopathic nephrotic syndrome, with varying degrees of proteinuria. Blood pressure and heart rate data were analyzed in relation to anthropometric and biochemical parameters. A total of 72 urine sample analyses, along with associated blood pressure measurements, were obtained from the charts of 33 children (males = 25). Results Diastolic blood pressure Z ‐scores were significantly higher in proteinuric patients (urine protein/creatinine >0.02 g/mmol) compared to non‐proteinuric patients ( P = .006; Cohen‐ d 0.97 [0.41; 1.53]). Systolic blood pressure was also significantly higher in proteinuric patients ( P = .04), but with a less significant effect size (Cohen‐ d 0.54 [−0.002; 1.08]). Proteinuria (>0.02 g/mmol) was the most significant predictor of diastolic ( β = .79, P = .04), but not systolic blood pressure elevation on multivariate analysis. Conclusions We observed a disproportionate increase in diastolic blood pressure vs systolic blood pressure in patients with proteinuria.

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Hypertension and its severity in children with steroid sensitive nephrotic syndrome during remission

Cited by 7 publications

References 19 publications

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

Hypertension in Childhood Nephrotic Syndrome

Diastolic hypertension is associated with proteinuria in pediatric patients

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