ESPN 51th Annual Meeting

ESPN 2018


 
The Evaluation of Left Ventricular Functions in Children with Steroid-Sensitive Nephrotic Syndrome
HULYA NALCACIOGLU 1 OZAN OZKAYA 2 CANDAS KAFALI 3 DEMET TEKCAN 1 KEMAL BAYSAL 3

1- ONDOKUZ MAYIS UNIVERSITY FACULTY OF MEDICINE, PEDIATRIC NEPHROLOGY DEPARTMENT, SAMSUN, TURKEY
2- ISTINYE UNIVERSİTY FACULTY OF MEDİCİNE, PEDİATRİC NEPHROLOGY AND RHEUMATOLOGY DEPARTMENT, ISTANBUL, TURKEY
3- ONDOKUZ MAYIS UNIVERSITY FACULTY OF MEDICINE, PEDIATRIC CARDIOLOGY DEPARTMENT, SAMSUN, TURKEY
 
Introduction:

Nephrotic syndrome has been associated with increased risk of cardiovascular diseases (CVD), which may be attributable to the hypoalbuminemia, dyslipidemia, hypercoagulopathy or inflammatory activation. In childhood minimal change disease is less prone to CVD because of the transient nature of the metabolic abnormalities and steroid exposure.  The aim of the present study was to evaluate the presence of cardiac systolic and diastolic dysfunction in pediatric patients with steroid – sensitive nephrotic syndrome (SSNS). 

Material and methods:

The study population consisted of 19 patients with SSNS (5.08 ± 2.41 years, 11 males) and 30 sex and age matched healthy controls. Two M-mode Conventional echocardiogram and Tissue Doppler Echocardiography (TDE) were recorded in debut and in remission period of SSNS patients and in controls.  

Results:

With regard to conventional pulse wave Doppler (cPWD), SSNS patients (both in debut and in remission period) had a higher peak of late diastolic flow velocities (A peak), and patients in debut had a lower E/A ratio compared to control group indicating diastolic dysfunction (overall p=0.003 and p=0.006, respectively). Based on TDI echocardiography results, patients in debut had a higher A′ and a lower E′/A′ ratio (overall p<0.001 and p=0.001, respectively). There was also a significant difference in the cPWD E/TDI E′ ratio between the patients showing an increased cPWD E/TDI E′ ratio in remission compared to in debut period (p=0.09). Diastolic function (E’/A’) was positively correlated with plasma albumin levels (r = 0.554, p =0.017) and negatively correlated with proteinuria (r= -0.524 p=0.002) in debut period. 

Conclusions:

Diastolic dysfunction is present in SSNS patients both in debut and remission periods. The persistence of LV dysfunction during remission period requires special attention during the follow-up period for early detection of cardiac abnormalities.