Relation between plasma lipids and relapse of idiopathic nephrotic syndrome in children

Abstract

Background: Nephrotic syndrome (NS) is one of the most common renal diseases in children. It is a chronicchildhood disorder with a course of relapse and remission. Hyperlipidemia is a constant feature (95% cases)of minimal change nephrotic syndrome (MCNS) having serum cholesterol >250 mg/dl. Both increased synthesisand decreased clearance of lipoproteins may contribute to the hyperlipoproteinemia which frequently complicatesthe NS. Persistent hyperlipidemia can lead to relapse of NS which is a potential risk factor for progression ofglomerular injury. Persistent hyperlipidemia and frequent relapse of NS are further responsible forcardiovascular disease and progressive glomerular damage leading to renal failure. This study was done todetermine relationship between plasma lipids and relapse of idiopathic NS in children.
 Methods: This prospective study was carried out from July 2015 to June 2017 at the Department of Paediatricsin Sylhet MAG Osmani Medical College Hospital. Patients with the diagnosis of NS fulfilling the inclusioncriteria were included in this study purposively. A total of 50 children were included into this study. Theprimary end point was to determine plasma lipids level in children having idiopathic NS at acute phase, inremission and at 6 months after completion of treatment. The secondary end point was to evaluate the relationshipbetween persistent hyperlipidemia in remission phase and relapse of NS.
 Results: Among 50 children with clinical diagnosis of NS, 35 were first episode and 15 were in relapse cases.Among the first episode NS cases serum lipids level were decreased significantly during remission but HDLwas increased, whereas in relapse cases even during remission serum lipids level were significantly higher.After six months of follow up, out of 50 patients 28 patients had persistent remission and 22 patients hadrelapsed. The relationship between plasma lipids level and the incidence of relapse showed that acute lipidfraction levels were not risk factor in relapsing NS. Only the triglyceride level during remission was a riskfactor in relapsing NS (p<0.035) with OR 5.4 and 95% CI [1.06, 25.4].
 Conclusion: Persistent hypertriglyceridemia and hypercholesterolemia in remission phase is a risk factor forrelapse of idiopathic NS in children.
 Birdem Med J 2020; 10(2): 97-102

Incidence and predictors of relapse among children with nephrotic syndrome at Assosa zone hospitals, Benishangul Gumuz Region, Northwest Ethiopia, 2022

“…As other variables remained constant, children with high serum triglyceride levels at remission had a 2.74 times greater hazard of relapse than those with a serum triglyceride level below 110 mg/dl. It was in agreement with the studies done in Bangladesh (44%) (35), India (56%) (36), and Ethiopia (88%), (14), which showed that elevated triglyceride levels during remission were a predictor of relapse. Congruently, in this study, 52% of children with elevated triglyceride levels experienced relapse.…”

Lipoproteins and cholesterol homeostasis in paediatric nephrotic syndrome patients

“…Other studies also reported persistent lipid abnormalities during a prolonged period of disease remission ( 5 - 7 ). According to the results from previous studies, hyperlipidaemia during remission predicts relapse in idiopathic NS ( 21 , 22 ). The survival rate of children with NS has remarkably improved with corticosteroid therapy.…”

Serum lipid profile among pediatric folk with idiopathic nephrotic syndrome: An Observational Study

“…Mahmud et al, 2011 concluded that increased serum cholesterol levels during the remission phase might be associated with subsequent relapse in NS, and total serum cholesterol may be regarded as a predictor of relapse in childhood Idiopathic NS 28 . Kabir et al, 2020 reported that only the triglyceride level during remission was a risk factor in relapsing NS 23 .…”