A study on intima- media thickness of carotid artery in children with nephrotic syndrome: a cross sectional study
Abstract
Introduction: Atherosclerosis is one of the complications of Nephrotic syndrome. It is due to frequent exposure to hyperlipidemia, hypertension, and hypoproteinemia, steroid and immunosuppressive therapy may also contribute to the risk for cardiovascular diseases.
Objective: To evaluate intima- media thickness of carotid artery in children with nephrotic syndrome.
Design: A cross sectional study.
Setting: The study was done in Nehru hospital of B.R.D Medical College Gorakhpur (U.P.) from June 2014- March 2015.
Material & Methods: Total 150 children divided in to study group (n1=50) and control group II (n2=100). (n1=50) children with history of nephrotic syndrome enrolled in this study. The Inclusion criteria were nephrotic syndrome with normal serum complement, being on therapy for nephrotic syndrome (continuous or interrupted) for at least one year, glomerular filtration rate more than 90 ml/ min/ 1.73 m2 and age above two years at the time of study. (N2=100) healthy age, sex weight, height and RBS matched children considered as control group. The cIMT was evaluated in nephrotic children. Chi square test was used to test difference among study and control groups. A P value less than 0.05 was considered statistically significant.
Result: In the study group (n1=50) steroid resistant, steroid dependent, steroid sensitive and infrequent relapse nephrotic syndrome included one-fourth each. The mean cIMT (mm) in nephrotic children was 0.42(±0.14) while mean cIMT in control was 0.34 (±0.06) and (p <0.0014). Subsequently, the factor that influenced on thickness of cIMT were BMI, SBP, DBP, Total cholesterol, VLDL, LDL, TGs, serum protein ((p<0.05) and duration of disease (r=0.83).
Conclusion: cIMT was thicker in nephrotic children, were influenced by the factor that increases thickness of cIMT were hyperlipidemia, hypertension, hypoproteinemia and duration of disease.
Downloads
References
Grimm RH Jr, Svendsen KH, Kasiske B, Keane WF, Wahi MM. Proteinuria is a risk factor for mortality over 10 years of follow-up. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Kidney Int Suppl. 1997 Dec;63:S10-4.
Portman RJ, HawkinsE, Verani R. Premature atherosclerosis in pediatric renal patients : report of the southest pediatric Nephrology study Group.PediatrNephrol 1991; 4: 1-10.
Dirisamer A, Hachemian N, Bucek RA, Wolf F, Reiter M, Widhalm K. The effect of low-dose simvastatin in children with familial hypercholesterolaemia: a 1-year observation. Eur J Pediatr. 2003 Jun;162(6):421-5. Epub 2003 Mar 15. [PubMed]
Matsushima H, Yamasaki Y, NaoK, Kawamori R, Kamada T. Ultrasonographic measurement of the carotid artery wall thickness in diabetic patients (in Japanese). J Jpn Diabetes Soc 1990; 3: 941-45. [PubMed]
Spencer MP, Reid JM. Quantitation of carotid stenosis with continuous-wave (C-W) Doppler ultrasound. Stroke. 1979 May-Jun;10(3):326-30. [PubMed]
Litwin M, Niemirska A. Intima-media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol. 2009 Apr;24(4):707-19. doi: 10.1007/s00467-008-0962-3. Epub 2008 Sep 11. [PubMed]
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007 Jan 30;115(4):459-67. Epub 2007 Jan 22. [PubMed]
Wang JG, Staessen JA, Li Y, Van Bortel LM, Nawrot T, Fagard R, Messerli FH, Safar M. Carotid intima-media thickness and antihypertensive treatment: a meta-analysis of randomized controlled trials. Stroke. 2006 Jul;37(7):1933-40. Epub 2006 Jun 8.
Tkaczyk M, Czupryniak A, Owczarek D, Lukamowicz J, Nowicki M. Markers of endothelial dysfunction in children with idiopathic nephrotic syndrome. Am J Nephrol. 2008;28(2):197-202. Epub 2007 Oct 24.
Leno C, Pascual J, Polo JM, Berciano J, Sedano C. Nephrotic syndrome, accelerated atherosclerosis, and stroke. Stroke. 1992 Jun;23(6):921-2. [PubMed]
Hopp L, Gilboa N, Kurland G, Weichler N, Orchard TJ. Acute myocardial infarction in a young boy with nephrotic syndrome: a case report and review of the literature. Pediatr Nephrol. 1994 Jun;8(3):290-4. [PubMed]
Kniazewska MH, Obuchowicz AK, Wielkoszyn´ski T, Zmudzin´ska-Kitczak J, Urban K, Marek M, et al. Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome. PediatrNephrol 2009;24:549-54.
Ksiazek J, Niemirska A, Lipka M, Grenda R. [Evaluation of arterial intima-media thickness (IMT) in children with idiopathic nephrotic syndrome--preliminary report]. Przegl Lek. 2006;63 Suppl 3:205-7.
Tang R, Hennig M, Thomasson B, Scherz R, Ravinetto R, Catalini R, Rubba P, Zanchetti A, Bond MG. Baseline reproducibility of B-mode ultrasonic measurement of carotid artery intima-media thickness: the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens. 2000 Feb;18(2):197-201.
Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997 Sep 2;96(5):1432-7.
Ludwig M, von Petzinger-Kruthoff A, von Buquoy M, Stumpe KO. [Intima media thickness of the carotid arteries: early pointer to arteriosclerosis and therapeutic endpoint]. Ultraschall Med 2003; 24:162-74. German. Comment in: p. 151-2.
Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA; Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC investigators. Stroke 1993; 24:1297-304.
Poredos P. Intima-media thickness: indicator of cardiovascular risk and measure of the extent of atherosclerosis. Vasc Med. 2004 Feb;9(1):46-54. [PubMed]
Bots ML, Grobbee DE. Intima media thickness as a surrogate marker for generalised atherosclerosis. Cardiovasc Drugs Ther. 2002 Jul;16(4):341-51. [PubMed]
Hulthe J, Wikstrand J, Emanuelsson H, Wiklund O, de Feyter PJ, Wendelhag I. Atherosclerotic changes in the carotid artery bulb as measured by B-mode ultrasound are associated with the extent of coronary atherosclerosis. Stroke. 1997 Jun;28(6):1189-94. [PubMed]
Taylor AJ, Kent SM, Flaherty PJ, Coyle LC, Markwood TT, Vernalis MN. ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation. 2002 Oct 15;106(16):2055-60.
ISKDC: The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone, J Pediatr 98 (4):561-64, 1981.
Niaudet P: Steroid-resistant idiopathic nephrotic syndrome in children. In Avner ED, Harmon WE, Niaudet P, editors: Pediatric nephrology, Philadelphia, 2004, Lippincott Williams & Wilkins.
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F; European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012 Jul;33(13):1635-701. doi: 10.1093/eurheartj/ehs092. Epub 2012 May 3.
Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013 Jul;34(28):2159-219. doi: 10.1093/eurheartj/eht151. Epub 2013 Jun 14.
Stein JH, Korcarz CE, Hurst RT, etal. American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008 Feb;21(2):93-111; quiz 189-90. doi: 10.1016/j.echo.2007.11.011.
Greenland P, Alpert JS, Beller GA, etal. American College of Cardiology Foundation; American Heart Association. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2010 Dec 14;56(25):e50-103. doi: 10.1016/j.jacc.2010.09.001.
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2935-59. doi: 10.1016/j.jacc.2013.11.005. Epub 2013 Nov 12.
Gonzalez J, Wood JC, Dorey FJ, Wren TA, Gilsanz V. Reproducibility of carotid intima-media thickness measurements in young adults. Radiology. 2008 May;247(2):465-71. doi: 10.1148/radiol.2472070691. Epub 2008 Mar 18.
Luo X, Yang Y, Cao T, Li Z. Differences in left and right carotid intima-media thickness and the associated risk factors. Clin Radiol. 2011 May;66(5):393-8. doi: 10.1016/j.crad.2010.12.002. Epub 2011 Feb 15. [PubMed]
Srivastava RN, Mayekar G, Anand R, Choudhry VP, Ghai OP, Tandon HD. Nephrotic syndrome in indian children. Arch Dis Child. 1975 Aug;50(8):626-30. [PubMed]
Farida Ahmed Farid, Ahmed Abdullah Mohammed, Hanaa Mohammed Afifi, and Rania Saleh Beltagi; Tissue factor pathway inhibitor in paediatric patients with nephrotic syndrome: SAJCH. 2011 Dec; 5(4): 107–111. [PubMed]
Nakysa Hooman, Roya isa-Tafreshi, Hasan Otukesh, Seyed-Hassan Mostafavi, , Farideh Hallaji;carotid Artery Function in Children with Idiopathic Nephrotic Syndrome: Nefrologia (English Version) 2013;33:650-6 doi:10.3265/Nefrologia.pre2013.May.12036. [PubMed]
Tkaczyk M, Czupryniak A, Owczarek D, Lukamowicz J, Nowicki M. Markers of endothelial dysfunction in children with idiopathic nephrotic syndrome. Am J Nephrol 2008;28:197-202. [PubMed]
Dnyanesh DK, Suma Dnyanesh, Varadaraj Shenoy. A Study of Serum Lipids in Nephrotic Syndrome in Children. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 13, Issue 3 Ver. I. (Mar. 2014), PP 01-06 available from:www.iosrjournals.org
Meltem Dinleyici, Bilal Yildiz, Nuran Çetin, Nurdan Kural, Ozkan Alatas; Serum and urinary leptin and ghrelin in children with nephrotic syndrome: Neuroendocrinol Lett.Vol. 34 2013; 34(5):388–394available online: http://node.nel.edu
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007;115:459-67. [PubMed]
Sarama Saha, Chandan Sarkar, Subhash Chandra Biswas and R Karim; correlation between serum lipid profile and carotid intima-media thickness in polycystic ovarian syndrome. Indian Journal of Clinical Biochemistry, 2008 / 23 (3) 262-266. [PubMed]
Kniazewska MH, Obuchowicz AK, Wielkoszy¿ski T, Zmudzi¿ska-Kitczak J, Urban K, Marek M, ; Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome. Pediatr Nephrol 2009; 24:549-54.
Niaudet P, Boyer O. Idiopathic nephrotic syndrome in children: clinical aspects. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N (eds.). Pediatric Nephrology. Berlin Heidelberg: Springer-Verlag; 2009. p. 667-702.
Falgun Gosai, Hetal Patel;Relationship Between Carotid Intima Media Thickness And Lipid Profile In Type Two Diabetes Mellitus And Stage 2 Hypertension; NJIRM 2014; Vol. 5(2). March-April eISSN: 0975-9840 pISSN: 2230 - 9969.
Mona H El Samahy, Randa M Matter, Omneya I Youssef, Manal A Shams El Din El Telbany and Nermeen A Kamal; Relation between carotid intima media thickness and oxidative stress markers in type 1 diabetic children and adolescents; J Diabetes Metab Disord. 2013; 12: 50.Published online 2013 Dec 19. doi: 10.1186/2251-6581-12-50.
F.L. Plavnik, S. Ajzen, O. Kohlmann Jr., A. Tavares, M.T. Zanella, A.B. Ribeiro and O.L. Ramos ;Intima-media thickness evaluation by B-mode ultrasound. Correlation with blood pressure levels and cardiac structures; Braz J Med Biol Res, January 2000, Volume 33(1) 55-64.
Jonathan M. Sorof, Andrei V. Alexandrov, Gina Cardwell, Ronald J. Portman;Carotid Artery Intimal-Medial Thickness and Left Ventricular hypertrophy in Children With Elevated Blood Pressure: January 2003, VOLUME 111 / ISSUE 1.
Marc B. Lande, Nancy L. Carson, Jason Roy, Cecilia C. Meagher; Effects of Childhood Primary Hypertension on Carotid Intima Media Thickness A Matched Controlled Study.; (Hypertension. 2006;48:40-44.) available from: https://doi.org/10.1161/01.HYP.0000227029.10536.e8.
Schiel R , Beltschikow W , Radón S , Kramer G , Perenthaler T , Stein G ; increased carotid intima-media thickness and associations with cardiovascular risk factors in obese and overweight children and adolescents. European Journal of Medical Research [2007, 12(10):503-508]
Stella Stabouli, VasiliosKotsis, Christina Karagianni, Nikos Zakopoulos, Andreas Konstantopoulos; Blood Pressure and Carotid Artery Intima-Media Thickness in Children and Adolescents: The Role of Obesity, Hellenic J Cardiol 2012; 53: 41-47 available from: http://www.hellenicjcardiol.org/archive/full_text/2012/1/2012_1_41.pdf
Nicole L. Spartano,Jacqueline A. Augustine, Wesley K. Lefferts, Brooks B. Gump, Kevin S. Heffernan. The relationship between carotid blood pressure reactivity to mental stress and carotid intima-media thickness October 2014, Volume 236, Issue 2, Pages 227-229; DOI: http://dx.doi.org/10.1016/j.atherosclerosis.2014.07.014.
Sorof JM, Cardwell G, Franco K, Portman RJ;Ambulatory blood pressure and left ventricular mass index in hypertensivechildren,Hypertension. 2002Apr;39(4):903-8.
Copyright (c) 2017 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
OAI - Open Archives Initiative
