A, The the incidence of hypertension in children with nephrotic syndrome in comparison with low & high risk group & associated risk factors

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Abstract

The Incidence of Hypertension In Children With Nephrotic Syndrome in Comparison with Low & High Risk Group & Associated Risk Factors

Abstract

Background: Hypertension is very common among Nephrotic patients. In Nephrotic Syndrome, the kidneys become leaky so massive protein leaks into urine, decreasing the plasma colloid osmotic pressure and then fluid flows into tissue space. Nephrotic Syndrome also can cause water and sodium retention. Fluid retention in body can cause increased blood volume, leading to hypertension. hypertension is one of the most common sequelae of chronic kidney disease (CKD) in pediatric age group. CKD associated HTN develops by a large variety of pathophysiological mechanisms. BP is one of the most critical determinants of the progression rate of renal failure in children and cardiovascular mortality in childhood onset renal failure.

Objective: To study the relative frequency of hypertension in children with nephrotic syndrome & the factors that increase the incidence of hypertension in these patients &To compare the incidence of hypertension in patients with nephrotic syndrome, patient with chronic kidney disease & normal population as low, medium, high risk groups.

Patients & methods: A cross sectional study which was carried out in Nephrology Department at Central Child Teaching hospital & Al-Karamah Teaching hospital with total of 102 patients with nephrotic syndrome diagnosed and or treated and followed up in the pediatric nephrology consultation clinic & nephrology ward during 2016 & 2017 & with measurement of blood pressure of 102 child with no history of any disease who visit the outpatient clinics in Central Child Teaching hospital over 8 months period from 1st of may to the 1st of September 2017, this study also included measurement of blood pressure for 51 patients with chronic kidney disease who admitted to Hemodialysis Centre in Central Child Teaching hospital during 2016 & 2017.

Results: In this study, the total number of cases of nephrotic syndrome, CKD, & normal children were 102, 51, 102 cases respectively, male to female ratio was 1.5:1 for both nephrotic syndrome & normal children while it was 1.8:1 for CKD patients. HT was reported in 2 cases only of total 102 cases of normal population (2%) & in 33 cases of total 102 cases of nephrotic syndrome (32.3%) While it reported in 29 cases of total 51 cases of CKD (56.9%). there is no significant association between gender, age at time of presentation, & family history of renal disease with hypertension in nephrotic patients while there is significant correlation between family history of HTN, abnormal renal function tests, type of nephrotic according to relapse or steroid response or histological types on renal biopsy & type of treatment with hypertension in nephrotic patients. Hypertension was reported in 11 nephrotic patients with initial attack (10.8%) while it developed later in 22 patients (21.6%). only one patient out of 21 patients (4.8%) of induction group was hypertensive initially, while 5 patients out of 34 patients (14.7%) with Sensitive group were hypertensive. With frequent relapses & dependence group, hypertension was reported in 16 patients among 29 patients (55.2%) with frequent relapses, while in resistance cases, hypertension was reported in 11 cases out of 18 cases (61.1%), among 16 patients with elevated blood urea, hypertension reported in 10 patients (62.5%),  while of 14 patients with elevated s.creatinine, hypertension developed in 9 patients (64.3%). HT was found in 21 patients among 82 patients who treated with steroid only (25.6%), while HT was found in 13 patients among 20 patients who received steroids & 2nd line of therapy (65%).

Conclusions: Nephrotic syndrome can be considered to be intermediate risk factor for development of HT between normal children & CKD, incidence of hypertension in CKD in this study is more than 50%. Hypertension developed later in nephrotic patients more than it developed at initial presentation. Hypertension was reported more in nephrotic patients with positive family history of hypertension. Hypertension was found to be more  in SRNS & SDNS group than in SSNS group. Hypertension  also was found to be more  in FRNS. The incidence of hypertension was more in nephrotic patients with elevated blood urea & S.Creatinine than in patient with normal renal function. Hypertension was found to be more in nephrotic patients not responding to steroid only & treated with 2nd line of therapy.

Key words: Hypertension, Nephrotic Syndrome, Chronic Kidney Disease.