Información de la revista
Vol. 33. Núm. 5.Septiembre 2013
Páginas 623-868
Vol. 33. Núm. 5.Septiembre 2013
Páginas 623-868
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Función de la arteria carótida en niños con síndrome nefrótico idiopático
Carotid Artery Function in Children with Idiopathic Nephrotic Syndrome
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Nakysa Hoomana, Roya Isa-Tafreshib, Hasan Otukeshc, Seyed-Hassan Mostafavid, Seyed-Hassan Mostafavie, Farideh Hallajie
a Pediatric Nephrology, Pediatric Transplantation and Dialysis Research Center(PTDRC), Ali-Asghar children hospital, Iran University of Medical Sciences,, Tehran, Iran,
b Pediatric Cardiology, Ali Asghar children hospital, Iran University of Medical Sciences,, Tehran, Iran,
c Pediatric Nephrology, Pediatric Transplantation and Dialysis Research Center(PTDRC), Ali-Asghar children hospital, Iran University of Medical Sciences, Tehran, Iran,
d Pediatric Radiology, Department of Radiology, Ali-Asghar children hospital, Iran University of Medical Sciences, Tehran, Iran,
e Pedaitric Radiology, Department of Radiology, Ali-Asghar children hospital, Iran University of Medical Sciences, Tehran, Iran,
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Antecedentes: Los pacientes con síndrome nefrótico son propensos a sufrir aterosclerosis como consecuencia de las frecuentes exposiciones a medicamentos para la hiperlipidemia, la hipertensión e inmunodepresores. Objetivos: Hemos estudiado los parámetros de la carótida como indicadores tempranos de aterosclerosis en niños con síndrome nefrótico. Métodos: 51 niños con antecedentes de síndrome nefrótico participaron en el estudio entre 2008 y 2011. Los criterios de inclusión fueron: síndrome nefrótico idiopático con complemento sérico normal, al menos un año después del comienzo de la enfermedad, índice de filtración glomerular superior a 20 ml/min/1,73 m2, mayor de dos años de edad en el momento del estudio. Se tuvo en consideración a setenta y cinco niños del mismo sexo y edad como grupo de control. Se estudiaron los parámetros de la función carótida y el índice de masa ventricular izquierda en niños con síndrome nefrótico. Resultados: Síndrome nefrótico sensible a esteroides, resistente a esteroides y dependiente de esteroides a partes iguales. El grosor íntima-media carotídeo medio (mm) en niños con síndrome nefrótico fue de 0,42 (±0,14), mientras que la TMIR media en controles fue de 0,37 (±0,08) (valor p <0,05). Tras la transformación logarítmica, los análisis multivariables lineales generales revelaron una diferencia significativa de grosor íntima-media carotídeo en pacientes con síndrome nefrótico (valor p <0,001). Posteriormente, el factor que influyó sobre la TMIR fue la duración de la enfermedad (p <0,05). Conclusiones: La mitad de los niños con síndrome nefrótico a los que se les realizó una ecocardiografía presentó hipertrofia ventricular izquierda. Se correlacionó con la rigidez carotídea y la hipertensión sistólica.

Palabras clave:
Síndrome nefrótico idiopático
Palabras clave:
Niño
Palabras clave:
Hipertrofia ventricular izquierda
Palabras clave:
Grosor íntima-media carotídeo

Background: Nephrotic patients are prone to atherosclerosis in consequence of frequent exposures to hyperlipidemia, hypertension, and immunosuppressive drugs. Objectives: We studied the carotid parameters as early indicators of atherosclerosis in children with nephrotic syndrome. Methods: Between 2008 and 2011, 51 children with history of nephrotic syndrome enrolled in the study. The inclusion criteria were: idiopathic nephrotic syndrome with normal serum complement, at least one year after initiation of disease, glomerular filtration rate more than 20mL/min/1.73m2, age over two years old at the time of study. Seventy-five healthy sex-age-matched children considered as a control group. Carotid function parameters and left ventricular mass index were studied in nephrotic children. Results: Steroid sensitive, resistant, and dependent nephrotic syndrome included one-third each. The mean carotid intima-media thickness (mm) in nephrotic children was 0.42 (±.14) while the mean cIMT in controls was 0.37 (±.08) (p-value <.05). After log transformation, General Linear Multivariate analysis revealed significant difference of carotid intima-media thickness in nephrotic patients (p-value <.001). Subsequently, the factor that influenced on cIMT was duration of disease (P<.05). One-half of nephrotic children who had echocardiography, showed left ventricular hypertrophy. It was correlated with carotid stiffness and systolic hypertension (P<.05). Conclusions: Carotid intima-media thickness was thicker in nephrotic children. Carotid parameters were influenced by duration of disease and hypertension. 

Keywords:
Nephrotic Syndrome, Idiopathic
Keywords:
Child
Keywords:
Hypertrophy, Left Ventricular
Keywords:
Carotid Intima- Media Thickness
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Bibliografía
[1]
Litwin M, Niemirska A. Intima¿media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol 2009;24:707-19. [Pubmed]
[2]
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]
[3]
Wang JG, Staessen JA, Li Y, Van Bortel LM, Nawrot T, Fagard R, et al. Carotid intima-media thickness and antihypertensive treatment: a meta-analysis of randomized controlled trials. Stroke 2006;37:1933-40.  [Pubmed]
[4]
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]
[5]
Leno C, Pascual J, Polo JM, Berciano J, Sedano C. Nephrotic syndrome, accelerated atherosclerosis, and stroke. Stroke 1992;23:921-2.
[6]
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;8:290-4. [Pubmed]
[7]
Kniazewska MH, Obuchowicz AK, Wielkoszy¿ski T, Zmudzi¿ska-Kitczak J, Urban K, Marek M, et al. Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome. Pediatr Nephrol 2009;24:549-54. [Pubmed]
[8]
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;63:205-7. [Pubmed]
[9]
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.
[10]
Aggoun Y, Sidi D, Levy BI, Lyonnet S, Kachaner J, Bonnet D. Mechanical properties of the common carotid artery in Williams syndrome. Heart 2000;84:290-3. [Pubmed]
[11]
Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, et al. Presence of increased stiffness of the common carotid artery and enodethelial dysfunction in severely obese children: a prospective study. Lancet 2001;358:1400-4. [Pubmed]
[12]
Tafreshi RI, Human N, Otukesh H, Nikavar A. Evaluation of combined left ventricular function using the myocardial performance index in children with chronic kidney disease. Echocardiography 2011;28:97-103. [Pubmed]
[13]
Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 1987;34:571-90. [Pubmed]
[14]
Bussy C, Boutouyrie P, Lacolley P, Challande P, Laurent S. Intrinsic stiffness of the carotid arterial wall material in essential hypertensives. Hypertension 2000;35:1049-54. [Pubmed]
[15]
Otukesh H, Otukesh S, Mojtahedzadeh M, Hoseini R, Fereshtehnejad SM, Riahi Fard A, et al. Management and outcome of steroid-resistant nephrotic syndrome in children. Iran J Kidney Dis 2009;3:210-7. [Pubmed]
[16]
Hoseini R, Otukesh H, Fereshtehnejad SM, Tahoori A, Hooman N, Rahimzadeh N, et al. Prevalence and outcome of focal segmental glomerulosclerosis in Iranian children with nephrotic syndrome. Iran J Kidney Dis 2012;6:18-24. [Pubmed]
[17]
Nickavar A, Safarzadeh AE, Sotoudeh K, Otukesh H, Hooman N. Mycophenolate mofetil for treatment of idiopathic nephrotic  syndrome in children. Iran J Kidney Dis 2012;6:346-9. [Pubmed]
[18]
Hooman N, Esfehani ST, Madani A, Bodagi E, Mohseni P. Clinicopathologic features and outcomes of membranous nephropathy in Markaz tebi children hospital. Iranian Journal of Pathology 2006;1:69-74.
[19]
Simpson JM, Savis A, Rawlins D, Qureshi S, Sinha MD. Incidence of left ventricular hypertrophy in children with kidney disease: impact of method of indexation of left ventricular mass. Eur J Echocardiogr 2010;11:271-7. [Pubmed]
[20]
Brumback LC, Kronmal R, Heckbert SR, Ni H, Hundley WG, Lima JA, et al. Body size adjustments for left ventricular mass by cardiovascular magnetic resonance and their impact on left ventricular hypertrophy classification. Int J Cardiovasc Imaging 2010;26:459-68. [Pubmed]
[21]
Hooman N, Mostafavi SH, Hallaji F, Isa-Tafreshi R, Otukesh H. The Correlation between Atherosclerosis Risk Factors and Carotid Intima Media Thickness in Children with Nephrotic Syndrome. Pediatr Nephrol 2010;25:1957. [Pubmed]
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