Blood Pressure and Visit-to-Visit Blood Pressure Variability Among Individuals With Primary Proteinuric Glomerulopathies

Sethna, Christine B.; Meyers, Kevin; Mariani, Laura; Psoter, Kevin J.; Gadegbeku, Crystal A.; Gibson, Keisha; Srivastava, Tarak; Kretzler, Matthias; Brady, Tammy M.

doi:10.1161/hypertensionaha.117.09475

Cited by 23 publications

(14 citation statements)

References 29 publications

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“…Greater systolic and diastolic standard deviation (SD) and average real variability were associated with greater hazard of reaching the composite end point in adults (all P < 0.01). In children, greater BPV was an independent predictor of composite endpoint (determined by systolic SD and average real variability) and complete remission (determined by systolic and diastolic average real variability); all P < 0.05 (16).…”

Section: Ambulatory Hypertension Abnormalities In Bp Circadian Rhythmentioning

confidence: 90%

“…A recent review of 147 children enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), consisting of 69 (46.9%) children with Minimal Change Disease (MCD), 49 (33.3%) with FSGS, 8 (5.4%) with IgA, 2 (0.04%) with Membranous Nephropathy, and 19 (12.9%) other glomerulopathy, showed that 69 (46.9%) had prior history of HTN or blood pressure ≥95th% at baseline visit. Authors reported no statistical difference in prevalence of hypertensive status between MCD (41%), FSGS (46.9%), and IgA (62.5%) subjects (16). This is possibly related to the preservation of kidney disease in the childhood years, lessening the effect of lower GFR usually seen with advancing age in FSGS patients.…”

Section: Epidemiologymentioning

confidence: 95%

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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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Section: Ambulatory Hypertension Abnormalities In Bp Circadian Rhythmentioning

confidence: 90%

Section: Epidemiologymentioning

confidence: 95%

Hypertension in Childhood Nephrotic Syndrome

Shatat

Becton²,

Woroniecki

2019

Front. Pediatr.

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“…The results reported by Sethna et al showed that the application of the association of BPV with renal outcomes could be extended to patients with primary glomerulopathy. Moreover, they further described a 5% increase in the occurrence of the composite endpoint (ESRD or eGFR decline < 40%) with a one-unit increase in the SD of SBP [22]. Aggressively lowering systolic blood pressure which lowers diastolic pressure to less than 70 mmHg may increase mortality risk for patients with chronic kidney disease according to an observational study [23].…”

Section: Discussionmentioning

confidence: 99%

Establishment of a novel nomogram for the clinically diagnostic prediction of minimal change disease, −a common cause of nephrotic syndrome

et al. 2020

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Background Minimal change disease (MCD) is one of the major causes of nephrotic syndrome (NS). A confirmed MCD diagnosis mainly depends on renal biopsy at present, which is an invasive procedure with many potential risks. The overall incidence of complications caused by renal biopsy procedures has been reported as approximately 11 and 6.6% outside and within China, respectively. Unfortunately, there is currently no noninvasive procedure or practical classification method for distinguishing MCD from other primary glomerular diseases available. Method A total of 1009 adult patients who underwent renal biopsy between January 2017 and November 2019 were enrolled in this study. Twenty-five parameters extracted from patient demographics, clinical manifestations, and laboratory test results were statistically analysed. LASSO regression analysis was further performed on these parameters. The parameters with the highest area under the curve (AUC) were selected and used to establish a logistic diagnostic prediction model. Results Of the 25 parameters, 14 parameters were significantly different (P < 0.05). MCD patients were mostly younger (36 (22, 55) vs. 41 (28.75, 53)) and male (59% vs. 52%) and had lower levels of diastolic blood pressure (DBP) (79 (71, 85.5) vs. 80 (74, 89)) and IgG (5.42 (3.17, 6.36) vs. 9.38 (6.79, 12.02)) and higher levels of IgM (1.44 (0.96, 1.88) vs. 1.03 (0.71, 1.45)) and IgE (160 (46.7, 982) vs. 47.3 (19, 126)) than those in the non-MCD group. Using the LASSO model, we established a classifier for adults based on four parameters: DBP and the serum levels of IgG, IgM, IgE. We were able to clinically classify adult patients with NS into MCD and non-MCD using this model. The validation accuracy of the logistic regression model was 0.88. A nomogram based on these four classifiers was developed for clinical use that could predict the probability of MCD in adult patients with NS. Conclusions A LASSO model can be used to distinguish MCD from other primary glomerular diseases in adult patients with NS. Combining the model and the nomogram potentially provides a novel and valuable approach for nephrologists to diagnose MCD, avoiding the complications caused by renal biopsy.

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“…37 The same study, when evaluating the adults with glomerulopathies, found that those with HT were at higher risk of developing end-stage renal disease in addition to a decrease of 40% or more in their estimated glomerular filtration rate. 37 Proteinuria, a characteristic of all dogs in our study, also is considered to be a clinical sign of target organ damage resulting from the effects of increased SBP on the kidney. 38 In a study of 45 dogs, those with a UPC ≥1 were found to have a mean SBP of 164 ± 23 mm Hg, which was significantly higher than those with UPC < 1.0 (139 ± 18 mm Hg).…”

Section: T a B L Ementioning

confidence: 92%

Clinicopathologic characteristics, pathology, and prognosis of 77 dogs with focal segmental glomerulosclerosis

Lorbach

Hokamp

Quimby

et al. 2020

Veterinary Internal Medicne

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Background: Focal segmental glomerulosclerosis (FSGS) is a common cause of nonimmune complex glomerulopathy and the prognosis and clinicopathologic findings associated with this condition have not been described in dogs. Objective: To characterize the presentation and identify clinical factors associated with the survival of dogs with FSGS. Animals: Seventy-seven dogs diagnosed with FSGS based on evaluation of renal biopsy samples submitted to the International Veterinary Renal Pathology Service. Methods: Retrospective review of medical records of dogs biopsied for evaluation of proteinuria between January 2015 and May 2017. Results: The incidence of FSGS among all dogs biopsied for proteinuria was 26%. Significantly more females (48; 62.3%) than males (29; 37.7%) were affected (P = .04). At the time of biopsy, median serum creatinine concentration (SCr) was 1.2 mg/dL (range, 0.3-8.7), median serum albumin concentration (Alb) was 2.8 g/dL (range, 1.1-4.6), median systolic blood pressure was 153.5 mm Hg (range, 95-260), and median urine protein : creatinine ratio was 5.9 (range, 1.4-22). Median survival time after biopsy was 258 days (range, 26-1003) for dogs that died from all causes (n = 32). Factors that were associated with a shorter survival time included SCr ≥ 2.1 mg/dL (P < .01) and Alb < 2 g/dL (P < .01). Conclusions and Clinical Importance: Most dogs with FSGS were female, and although commonly hypertensive, azotemia, severe hypoalbuminemia and ascites or edema were observed infrequently. Variables significantly associated with survival time were SCr and Alb.

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Blood Pressure and Visit-to-Visit Blood Pressure Variability Among Individuals With Primary Proteinuric Glomerulopathies

Cited by 23 publications

References 29 publications

Hypertension in Childhood Nephrotic Syndrome

Hypertension in Childhood Nephrotic Syndrome

Establishment of a novel nomogram for the clinically diagnostic prediction of minimal change disease, −a common cause of nephrotic syndrome

Clinicopathologic characteristics, pathology, and prognosis of 77 dogs with focal segmental glomerulosclerosis

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