Risk factors associated with carotid intima-media thickness in pediatric nephrotic syndrome

Khairunnisa Khairunnisa -  Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Indonesia
Syafruddin Haris -  Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Indonesia
Isra Firmansyah -  Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Indonesia
Anidar Anidar -  Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Indonesia
Mulya Safri -  Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Indonesia
Herlina Dimiati* -  Department of Pediatrics, Faculty of Medicine, Universitas Syiah Kuala, Indonesia

Supp. File(s): Research Materials Covering Letters

Nephrotic syndrome (NS) is the most frequently occurring kidney disease among children and increases the morbidity and mortality of cardiovascular disorders caused by hyperlipidemia, increased thrombogenesis, and endothelial dysfunction that occur in atherosclerosis. Carotid intima-media thickness (CIMT) is an accessible, noninvasive, and sensitive method for detecting subclinical atherosclerosis. This study aimed to determine the risk factors for CIMT in children with idiopathic nephrotic syndrome at RSUD dr. Zainoel Abidin Banda Aceh. This was an observational analytic study with a cross-sectional design, conducted from March 2024 until May 2024. This study included 35 patients with NS who were 2-18 years, receiving treatment for a minimum of 6 months, with a glomerular filtration rate exceeding 90 ml/minute/1,73 m2, and no recent acute infections in the past 3 months. Bivariate analysis was performed using the Pearson correlation test, and independent T tests and multivariate analyses were performed using multiple linear regressions. We found a statistically significant correlation between CIMT and total cholesterol (p=0,004, r=0,471), steroid-resistant nephrotic syndrome (p=0,001) and systolic blood pressure (p=0,011, r=0,427) with a mean CIMT of 1,5 ± 0,4 mm. In conclusion, the total cholesterol level, steroid-resistant nephrotic syndrome, and systolic blood pressure are risk factors for CIMT in children with NS.

Supplement Files

Keywords : Idiopathic nephrotic syndrome, carotid intima media thickness, risk factors, children

  1. Abdel Massih, A., Haroun, M., Samir, M., Younis, S., Tamer, M., & Salem, A. (2021). Hypoalbuminemia linked to myocardial dysfunction in recent-onset nephrotic syndrome: a cross-sectional case control 3DSTE study. Egyptian Pediatric Association Gazette, 69(1), 1-8. https://doi.org/10.1186/s43054-021-00070-2
  2. Ahmed, H. M., Ameen, E. E. D., Awad, M. S., & Botrous, O. E. (2021). Assessment of carotid intima media thickness and left ventricular mass index in children with idiopathic nephrotic syndrome. Vascular Health and Risk Management, 17(10), 349–356. https://doi.org/10.2147/VHRM.S295868
  3. Al Qahtany, F. H. M., Al Shali, H. A., & Bayamin, A. A. (2018). Atherosclerosis : pathophysiology and management. The Egyptian Journal of Hospital Medicine, 70(1), 82–87. https://doi.org/10.12816/0042966
  4. Astuti, K. D., Muryawan, M. H., & Mellyana, O. (2015). Correlation between lipid profile and C-reactive protein in children with nephrotic syndrome. Paediatrica Indonesiana, 55(1), 1-6. DOI: https://doi.org/10.14238/pi55.1.2015.1-6.
  5. Au, S., Mo, A., Oa, O., Om, L., Oe, A., Ab, A., & Fo, N. (2018). Nutritional assessment of children with nephrotic syndrome attending a tertiary health facility: A case control study. Tropical Journal of Nephrology, 13(2), 97-103.
  6. Baek, H. S. (2022). Mechanism, clinical consequences, and management of dyslipidemia in children with nephrotic syndrome. Childhood Kidney Diseases, 26(1), 25–30. https://doi.org/10.3339/ckd.22.020
  7. Charfeddine, S., Yousfi, C., Maalej, B., Triki, F., Abid, L., & Kammoun, S. (2021). Acute myocardial infarction in a child with nephrotic syndrome. Revista Portuguesa de Cardiologia, 40(6), 457-457. https://doi.org/10.1016/j.repc.2018.06.018
  8. Dąbrowska, E., & Narkiewicz, K. (2023). Hypertension and dyslipidemia: the two partners in endothelium-related crime. Current Atherosclerosis Reports, 25, 605–612. DOI: https://doi.org/10.1007/s11883-023-01132-z.
  9. Ephraim, R., Brenyah, R., Osei, F.,Anto, E., Basing, A., & Darkwah, K. (2017). Demographic, clinical and therapeutic characteristics of children aged 0-15 years with nephrotic syndrome: A retrospective study of the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Asian Journal of Medicine and Health, 5(2), 1–9. https://doi.org/10.9734/ajmah/2017/33270
  10. Ferreira, J. P., Girerd, N., Bozec, E., Machu, J. L., Boivin, J. M., London, G. M., Zannad, F., & Rossignol, P. (2016). Intima-media thickness is linearly and continuously associated with systolic blood pressure in a population-based cohort (STANISLAS cohort study). Journal of the American Heart Association, 5(6), 1-9. https://doi.org/10.1161/JAHA.116.003529
  11. Hilmanto, D., Mawardi, F., Lestari, A. S., & Widiasta, A. (2022). Disease-associated systemic complications in childhood nephrotic syndrome: A systematic review. International Journal of Nephrology and Renovascular Disease, 15, 53-62. DOI: 10.2147/IJNRD.S351053.
  12. Idris, S. S. M., Nasir, A., Ismail, N. Z. A. N., Van Rostenberghe, H. A., & Ilias, M. I. (2020). Timing and predictive factors of developing chronic kidney disease in childhood-onset idiopathic nephrotic syndrome: An Asian experience. Singapore Medical Journal, 61(9), 483–486. https://doi.org/10.11622/smedj.2019096
  13. Jiang, W., Chen, M., Huang, J., Shang, Y., Qin, C., Ruan, Z., Li, S., Wang, R., Li, P., Huang, Y., Liu, J., & Xu, L. (2021). Proteinuria is independently associated with carotid atherosclerosis: a multicentric study. BMC Cardiovascular Disorders, 21(1), 1-10. https://doi.org/10.1186/s12872-021-02367-x
  14. Kamel, A. S., Abo Elnour, S. I., Ragaey Mahmoud, M. M., & Sayed Kamel, A. (2020). Cardiac performance evaluation in children with nephrotic syndrome. Fayoum University Medical Journal, 6(1), 18–27. DOI:10.21608/fumj.2020.114316.
  15. Kamel, A. S., AlGhawass, M. M. E., Sayed, M. A., & Roby, S. A. (2022). Evaluation of carotid intima media thickness in children with idiopathic nephrotic syndrome. Italian Journal of Pediatrics, 48(1), 1-8. https://doi.org/10.1186/s13052-022-01383-7
  16. Kari, J. A., Quinlan, C., Deanfield, J., Shroff, R., & Tullus, K. (2017). Endothelial dysfunction in children with steroid-resistant nephrotic syndrome. Iranian Journal of Pediatrics, 27(4), 1-4. https://doi.org/10.5812/ijp.8026
  17. Khoury, M., & Urbina, E. M. (2018). Cardiac and vascular target organ damage in pediatric hypertension. Frontiers in Pediatrics, 6. https://doi.org/10.3389/fped.2018.00148
  18. Kniazewska, M. H., Obuchowicz, A. K., Wielkoszyński, T., Zmudzińska-Kitczak, J., Urban, K., Marek, M., Witanowska, J., & Sieroń-Stoltny, K. (2009). Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome. Pediatric Nephrology, 24(3), 549–554. https://doi.org/10.1007/s00467-008-1029-1
  19. Mehta, A., Mishra, S., Ahmad, K., Tiwari, H., Singh, V., & Singh, A. (2019). Carotid intima media thickness in children with nephrotic syndrome: an observational case control study. Sudanese Journal of Paediatrics, 19(2), 110–116. https://doi.org/10.24911/sjp.106-1535804613
  20. Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., Chen, J., & He, J. (2016). Global disparities of hypertension prevalence and control. Circulation, 134(6), 441–450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912
  21. Paripović, A., Stajić, N., Putnik, J., Gazikalović, A., Bogdanović, R., & Vladislav, V. (2020). Evaluation of carotid intima media thickness in children with idiopathic nephrotic syndrome. Nephrologie et Therapeutique, 16(7), 420–423. https://doi.org/10.1016/j.nephro.2020.09.004
  22. Patnaik, S. K., Kumar, P., Bamal, M., Patel, S., Yadav, M. P., Kumar, V., Sinha, A., Bagga, A., & Kanitkar, M. (2018). Cardiovascular outcomes of Nephrotic syndrome in childhood (CVONS) study: A protocol for prospective cohort study. BMC Nephrology, 19(1), 1-10. https://doi.org/10.1186/s12882-018-0878-5
  23. Praisey, J. S., Nivedita, A. S. A., Lenin, M. R., & Prabhu, S. V. (2024). Determination of carotid intima-media thickness in children with nephrotic syndrome-a case-control study. International Journal of Academic Medicine and Pharmacy, 6, 1494-1497. https://doi.org/10.47009/jamp.2024.6.1.298
  24. Primashanti Dewi, D. A. D. (2019). Risk factors for steroid resistant nephrotic syndrome in children. Medicina, 50(1), 67-71. https://doi.org/10.15562/medicina.v50i1.67
  25. Qira Amalia, T., & Kunci, K. (2018). Aspek klinis, diagnosis dan tatalaksana sindroma nefrotik pada anak. Jurnal Kedokteran Nanggroe Medika,1(2),81-88.
  26. Qu, B., & Qu, T. (2015). Causes of changes in carotid intima-media thickness: a literature review. Cardiovascular Ultrasound, 13(1), 1–10. https://doi.org/10.1186/s12947-015-0041-4
  27. Sharma, B., Saha, A., Dubey, N. K., Kapoor, K., Anubhuti, Batra, V. V., & Upadhayay, A. D. (2014). Endothelial dysfuntion in children with idiopathic nephrotic syndrome. Atherosclerosis, 233(2), 704–706. https://doi.org/10.1016/j.atherosclerosis.2014.01.055
  28. Sodal, S. (2018). Lipid profile in children with Nephrotic syndrome. Pediatric Review: International Journal of Pediatric Research. www.pediatricreview.in
  29. Vijay, S. K., Abhishek, S. K., Kumar Singh, V., & Professor, A. (2017). Pediatric Review: International Journal of Pediatric Research A study on intima-media thickness of carotid artery in children with nephrotic syndrome: a cross sectional study. 2. www.pediatricreview.in
  30. Wang, Y., Chen, C., Lin, Q., Su, Q., Dai, Y., Chen, H., He, T., Li, X., Feng, R., Huang, W., Hu, Z., Chen, J., Du, S., Guo, P., & Ye, W. (2024). The ratio of systolic and diastolic pressure is associated with carotid and femoral atherosclerosis. Frontiers in Cardiovascular Medicine, 11, 1-12. https://doi.org/10.3389/fcvm.2024.1353945

Open Access Copyright (c) 2024 Khairunnisa, Syafruddin Haris, Isra Firmansyah, Anidar, Mulya Safri, Herlina Dimiati
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AcTion: Aceh Nutrition Journal
Published by: Department of Nutrition at the Health Polytechnic of Aceh, Ministry of Health.
Soekarno-Hatta Street, No. 168. Health Polytechnic of Aceh, Aceh Besar, 23352. Telp/Fax: 0651 46126 / 0651 46121.
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