Medip, IJCP-2856 O
Medip, IJCP-2856 O
Medip, IJCP-2856 O
DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20194184
Original Research Article
1
Department of Pediatrics, 2Department of Nephrology, Yenapoya Medical College Hospital, Mangalore, Karnataka,
India
3
Department of Pediatrics, Srinivas Institute of Medical Science and Research Centre, Mukka, Mangalore, Karnataka,
India
*Correspondence:
Dr. Anitha S. Prabhu,
E-mail: [email protected]
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Hypertension is been one of the most common co morbidity of this disease. It was mostly attributed to
sodium retention, which is a major clinical feature of nephrotic syndrome. These mechanisms likely have a role in the
development of hypertension in nephrotic syndrome, where hypertension may be difficult to control, and provide new
therapeutic options for the management of blood pressure in the setting of nephrotic syndrome. Objective of study the
prevalence of hypertension in children with NS and also the number of antihypertensive required to control it.
Method: A Retrospective study of the hospital records of 100 children diagnosed with nephrotic syndrome admitted
to Pediatric and Nephrology Ward at YMCH was accessed.
Results: In our study 35 (35%) of them were Infrequent relapse nephrotic syndrome (IFNS) and 35(35%) were
Frequent relapse nephrotic syndrome (FRNS) ,while 30 cases (30%) were First episode nephrotic syndrome (FENS).
65 cases were steroid sensitive, while 28 and 7 of them were steroid dependent and resistant respectively. Of the 100
study population 54 of them had hypertension while 46 of them did not develop it .Of the 54 hypertensive nephrotic
syndrome children, 15 of them (28.%) required three anti hypertensives to control the pressure, while 19 (35%) and
20 (37%) required single and dual anti hypertensives respectively.
Conclusion: Prevalence of hypertension is increasing among the children with nephrotic syndrome. Its more
prevalent among the male then female FRNS, SRNS and SDNS are more prone to develop hypertension and also they
needed two or more antihypertensives to control the hypertension, whereas hypertension in SSNS could be managed
with single drug.
Keywords: Epithelial sodium channel, Hypertension, Nephrotic Syndrome, Proteinuria, Steroid resistant nephrotic
syndrome
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Manasa M et al. Int J Contemp Pediatr. 2019 Nov;6(6):2340-2345
Moreover, studies have shown a higher prevalence of Patient who have three or less relapse a year.
initial and subsequent steroid resistance, a characteristics
not consistent with typical minimal change NS with a Frequent relapses
benign prognosis. The results suggest that in the current
era, NS in children may not be as benign as indicated by Two or more relapses in initial 6 months or more than
earlier studies. This changing trend of the disease as also three relapses in any 12 months.
increased the prevalence of hypertension in nephrotic
syndrome5. Hence the present study is on prevalence of Steroid dependence
hypertension in children with NS and also the number of
antihypertensive required to control it. Two consecutive relapses when on alternate day steroids
or within 14 days of its discontinuation.
Objective of the study to estimate the incidence of
hypertension and usage of Antihypertensives in children Steroid resistance
with nephrotic syndrome
Absence of remission despite therapy with daily
METHODS prednisolone at a dose of 2mg/kg/day for 4 weeks.
A Retrospective study was conducted at YMCH from Initial steroid resistance
2016 to 2018. A total of 100 children who were
diagnosed with Nephrotic Syndrome and admitted to Lack of remission at first episode of nephrotic syndrome.
Pediatric and Nephrology Ward at YMCH were included
in the study. The patients record were obtained from the Late steroid resistance
Medical Records Department and data such as relevant
history, general status, number of relapses, use of regular
Initially steroid sensitive, but later show steroid
antihypertensives, and blood pressure at admission and
resistance.
also the treatment given were taken.
The data was analyses using SPSS v 21. Chi-square test
Inclusion Criteria
was used to evaluate the statistically significant
relationship between variables.
1. The children admitted with Nephrotic Syndrome.
RESULTS
Exclusion Criteria
The total number of patients enrolled during the study
1. Patient with congenital Nephrotic Syndrome. period was 100.
2. The children who were taking Antihypertensive In our study the Males (68) outnumbered females (32)
treatment for any other cause of hypertension other with male to female ratio 2.1:1 and age range between 1-
than nephrotic syndrome. 18 years. A total of 26 patients (26%) were in the age
group <5 years, followed by 40 (40%) in the age group
Terminologies in nephrotic syndrome1,6 (5-10) and 34(34%) in age group > 10 years. In our study
35 (35%) of them were Infrequent relapse nephrotic
1ST episode syndrome (IFNS) and 35(35%) were Frequent relapse
nephrotic syndrome (FRNS), while 30 cases (30%) were
When a child is diagnosed with protienuria/nephrotic First episode nephrotic syndrome (FENS).65 cases were
syndrome for the first time is called 1st episode.
International Journal of Contemporary Pediatrics | November-December 2019 | Vol 6 | Issue 6 Page 2341
Manasa M et al. Int J Contemp Pediatr. 2019 Nov;6(6):2340-2345
steroid sensitive, while 28 and 7 of them were steroid hypertensive patients 41(75.9%) were male and
dependent and resistant respectively (Table 1). 13(24.1%) were female (Figure 1).
Hypertensive Normotensive
Steroid Sensitivity
Frequency Percentage Frequency Percentage
SSNS 20 37% 45 98%
SDNS 27 50% 1 2%
SRNS 7 13% 0 0
p value <0.001, r value = 0.05
International Journal of Contemporary Pediatrics | November-December 2019 | Vol 6 | Issue 6 Page 2342
Manasa M et al. Int J Contemp Pediatr. 2019 Nov;6(6):2340-2345
Of the 54 hypertensive nephrotic syndrome children, 15 0.098 and on chi square test p value is <0.001 which is
of them (28.%) required three antihypertensives to significant. (Table 4)
control the pressure, while 19 (35%) and 20 (37%)
required single and dual antihypertensives respectively. Majority of the hypertensive SDNS (37%) and SRNS
Within the subgroups of nephrotic syndrome 12(50%) of (71.4%) required three antihypertensive, while 70% (14)
the hypertensive FRNS required triple antihypertensives of the hypertensive SSNS responded well to single
while majority of the FENS (53.8%) responded well with therapy. 44.4% (12) of the hypertensive SDNS required
single drug. dual drugs to control hypertension. both p and r value,
<0.001 and 0.035 are reported respectively, which is
Hypertension in children with IRNS could be controlled significant. (Table 5)
with single (52.9%) or dual (47.1%) drugs. r value is
Table 4: No. of Antihypertensive requirement within the subgroup.
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Manasa M et al. Int J Contemp Pediatr. 2019 Nov;6(6):2340-2345
In this study 50% (12 cases) of hypertensive FRNS Adv Chronic kidney disease. 2015 May
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of <0.001 and also of the 34 patients with SDNS and 5. Kim JS, Bellew CA, Silverstein DM, Aviles DH,
SRNS, 44.1% (15 cases) required triple drug therapy, Boineau FG, Vehaskari VM. High incidence of
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