Nephrotic Syndrome and Hypertension

I. A L. Gabban, Nahla; Ahmed Abdullah, Essam; Nadhim Abd, Haider

	Nephrotic Syndrome and Hypertension
IRAQI JOURNALOF COMMUNITY MEDICINE
Article 1, Volume 23, Issue 4, 2010, Pages 271-276
Authors
Nahla I. A l. Gabban; Essam Ahmed Abdullah; Haider Nadhim Abd
Abstract
Abstract: Background: Primary nephrotic syndrome (NS) is characterized by massive proteinuria and hypoalbuminemia leading to edema. Hyperlipidemia, hypercholesterolemias are usually associated. Minimal change disease accounts for approximately 85% of cases less than seven years of age. This condition is characterized by a predictable and gratifying response to steroids and an excellent long-term prognosis. Aims of study: To study the relative frequency of hypertension in children with NS, and determine the complication rates. Methods: This prospective study was carried out in Nephrology Department at central pediatric teaching hospital and a total of (71) patients with nephrotic syndrome diagnosed and/ or treated and followed up in the pediatric nephrology consultation clinic through, clinical examination and investigation (GUE, CBP and others) that was carried out over 7 months period from 15th of Jan. 2008 to15th of July 2008. Patients with congenital nephrotic syndrome were excluded from the study. Results: The total number of patients enrolled during the study period was 71.Males (46) and females (25) with male to female ratio 1.8:1. Age range between 1-18 years. A total of 50 patients (70%) (Male and female) were in the age group 1-5 years, followed by 17(23.9%) in the age group (6-10) and 4(5.6%) in age group > 10 years. According to sex distribution of the patients with nephrotic syndrome in relation to hypertension in which it presented in 18 males, 4 patients (5.6%) developed HT at initial attack and 14 patients (19.7%) later on ,while in females 10patients developed HT ,1 patient (1.4%) initially and 9 patients (12.7%) later on .The numbers of patients presented with initial attack 9(12.7%) ,infrequent relapses was present in 20(28.2%) ,while frequent relapses presented in 42 patients (59.2%) .Steroid therapy was given to all patients with initial attack and relapses. Steroid sensitive nephrotic syndrome was found in 33 (46.5%), steroid dependent nephrotic syndrome and steroid resistant nephrotic syndrome in28 (39.4%) and 10(14.1%) respectively. Hypertension was presented in 5 patients (7%) with initial attack,23 patients (32.4%) developed hypertension later .While in later hypertension, 4 patients (5.6%) with infrequent relapses found to be hypertensive and 16 patients (22.5%) with frequent relapses had hypertension, and only 3(4.2%)with no relapse had hypertension. Hypertension was found in 5 patients (7%) with steroid sensitive nephrotic syndrome, 9 patients (12.6%) with steroid resistant nephrotic syndrome and 14 patients (19.7%) with steroid dependent nephrotic syndrome. Abnormal renal function was presented in 8 cases (11.26%), only2cases (2.8%) of them developed hypertension later on. Acute renal failure was reported in 3cases (4.20%), 42 patients (59.20%) had urinary tract infection, one patient (1.40%) developed thrombosis, peritonitis was reported in 4 cases (5.6%) and respiratory tract infection was reported in 9cases (12.70%).Family history of hypertension was reported in 4cases (5.6%).Family history of renal problems were reported in 8 cases (11.3%) . Conclusions: Hypertension in patients with nephrotic syndrome presented in males more than females and is more in patients with frequent relapses and in steroid dependent nephrotic syndrome and steroid resistant nephrotic syndrome. Urinary tract infection was the most common complication. Keywords:

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