Arterial hypertension in children with nephrotic syndrome

Abstract

The review presents materials on the prevalence of NS in children, variants of its course: steroid-sensitive (SSNS) and steroidresistant (SRNS) steroid-dependent (SSNS). Minimal change nephrotic syndrome minimal changes (NSMC) is the most common glomerular disorder. Although NSMC has an excellent prognosis with a low risk of progression to t-CRF, its recurrent nature requires children to receive frequent courses of steroid therapy and other medications, many of which are known to affect blood pressure (BP). The interrelation of NS in children with arterial hypertension (AH) is shown. Prevalence of hypertension in children with SCNS, SRNS, SZNS is given. The regulation of hypertension in children is mandatory in the treatment of NS, due to the fact that hypertension is not established in a timely manner, is insufficiently controlled and is often masked. Vascular dysregulation, fluid overload, increased cardiac output and peripheral vascular resistance, alone or in combination, can lead to hypertension in CKD. The use of modern methods to monitor and control blood pressure is critical for improving hypertension management and preventing target organ damage in children. 24-hour blood pressure measurements are an important tool in determining the prognosis and treatment of children with HC. Many comorbidities increase the risk of cardiovascular disease, including obesity, left ventricular hypertrophy (LVH), increased arterial stiffness (increased BMI, endothelial dysfunction), impaired glucose metabolism, and hyperlipidemia. The pathophysiological aspects of hypertension in children with NS are considered. The pathophysiology of hypertension in NS is complex, with many renal and extrarenal factors. Renal factors include sodium retention, fibrosis / decreased GFR, and progression of kidney disease, and a direct link between albuminuria and blood pressure has recently been described. Other factors include drug side effects, comorbidities and genetic predisposition. Sodium metabolism plays an important role in the development of edema and blood pressure regulation in NS. There are two main hypotheses for sodium retention in NS, the hypothesis of underfilling and overfilling. The role of the epithelial sodium channel (ENC), atrial natriuretic peptide (ANP), nitric oxide (NO), steroid hormones and other drugs in sodium retention and the pathogenesis of hypertension is also considered. In children with NS, hypertension leads to target organs damage (TOD): left ventricular hypertrophy (LVH), damage to the organ of vision, cognitive impairment and more rapid progression of chronic kidney disease. Salt restriction and RAAS inhibition are considered integral parts of the treatment of children with proteinuria, and both are known to have blood pressure lowering effects. The RAAS blockade has a renoprotective effect in patients with glomerular damage. Studies have found greater reductions in proteinuria with ACE / ARB combination therapy. This renoprotective effect is explained by both a decrease in blood pressure and mechanisms independent of blood pressure. Lifestyle modifications, weight control, healthy eating, reduced sodium intake, supportive exercise, and basic drug therapy using angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics can slow the progression of NS in children.