Longitudinal analysis of blood pressure and lipids in childhood nephrotic syndrome

Johnathon Carboni; Elizabeth Thomas; Debbie S Gipson; Tammy M Brady; Tarak Srivastava; David T Selewski; Larry A Greenbaum; Chia-Shi Wang; Katherine M Dell; Frederick Kaskel; Susan Massengill; Kimberly Reidy; Cheryl L Tran; Howard Trachtman; Richard Lafayette; Salem Almaani; Sangeeta Hingorani; Rasheed Gbadegesin; Keisha L Gibson; Christine B Sethna; Nephrotic Syndrome Study Network (NEPTUNE)*

doi:10.1007/s00467-024-06301-z

Longitudinal analysis of blood pressure and lipids in childhood nephrotic syndrome

Pediatr Nephrol. 2024 Feb 6. doi: 10.1007/s00467-024-06301-z. Online ahead of print.

Authors

Johnathon Carboni¹, Elizabeth Thomas², Debbie S Gipson³, Tammy M Brady⁴, Tarak Srivastava⁵, David T Selewski⁶, Larry A Greenbaum⁷, Chia-Shi Wang⁷, Katherine M Dell⁸, Frederick Kaskel⁹, Susan Massengill¹⁰, Kimberly Reidy⁹, Cheryl L Tran¹¹, Howard Trachtman³, Richard Lafayette¹², Salem Almaani¹³, Sangeeta Hingorani¹⁴, Rasheed Gbadegesin¹⁵, Keisha L Gibson¹⁶, Christine B Sethna¹⁷; Nephrotic Syndrome Study Network (NEPTUNE)*

Collaborators

Nephrotic Syndrome Study Network (NEPTUNE)*:
K Dell, J Sedor, M Schachere, J Negrey, K Lemley, J Scott, T Srivastava, S Morrison, C Sethna, M Pfaiff, P Canetta, A Pradhan, L Greenbaum, C Wang, E Yun, S Adler, J LaPage, A Athavale, M Itteera, M Atkinson, T Dell, F Fervenza, M Hogan, J Lieske, G Hill, F Kaskel, M Ross, P Flynn, J Kopp, L Malaga-Dieguez, O Zhdanova, F Modersitzki, L Pehrson, R Lafayette, B Yeung, I Lee, S Quinn-Boyle, H Reich, M Hladunewich, P Ling, M Romano, A Fornoni, C Bidot, M Kretzler, D Gipson, A Williams, C Klida, V Derebail, K Gibson, A Froment, F Ochoa-Toro, L Holzman, K Meyers, K Kallem, A Swenson, K Sambandam, K Aleman, M Rogers, A Jefferson, S Hingorani, K Tuttle, L Manahan, E Pao, A Cooper, J J Lin, Stefanie Baker, M Kretzler, L Barisoni, C Gadegbeku, B Gillespie, D Gipson, L Holzman, L Mariani, M Sampson, J Sedor, J Zee, G Alter, H Desmond, S Eddy, D Fermin, M Larkina, S Li, C C Lienczewski, T Mainieri, R Scherr, A Smith, A Szymanski, A Williams, Carmen Avila-Casado, Serena Bagnasco, Joseph Gaut, Stephen Hewitt, Jeff Hodgin, Kevin Lemley, Laura Mariani, Matthew Palmer, Avi Rosenberg, Virginie Royal, David Thomas, Jarcy Zee, Laura Barisoni, Cynthia Nast

Affiliations

¹ Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA.
² Division of Nephrology, Department of Pediatrics, Dell Children's Medical Center, University of Texas, Austin, TX, USA.
³ Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
⁴ Division of Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Section of Nephrology, Children's Mercy Hospital and University of Missouri, Kansas City, MO, USA.
⁶ Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
⁷ Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁸ Center for Pediatric Nephrology and Hypertension, Cleveland Clinic Children's, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.
⁹ Division of Nephrology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA.
¹⁰ Division of Nephrology, Department of Pediatrics, Levine Children's Hospital, Charlotte, NC, USA.
¹¹ Division of Pediatric Nephrology, Department of Pediatrics and Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
¹² Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
¹³ Division of Nephrology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
¹⁴ Division of Nephrology, Department of Pediatrics, University of Washington, Seattle, WA, USA.
¹⁵ Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC, USA.
¹⁶ Division of Pediatric Nephrology, UNC Kidney Center, Chapel Hill, North Carolina, USA.
¹⁷ Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA. csethna@northwell.edu.

PMID: 38319465
DOI: 10.1007/s00467-024-06301-z

Abstract

Background: In the current study, longitudinal BP and lipid measurements were examined in a NEPTUNE cohort of children with newly diagnosed nephrotic syndrome (cNEPTUNE). We hypothesized that hypertensive BP and dyslipidemia would persist in children with nephrotic syndrome, regardless of steroid treatment response.

Methods: A multi-center longitudinal observational analysis of data obtained from children < 19 years of age with new onset nephrotic syndrome enrolled in the Nephrotic Syndrome Study Network (cNEPTUNE) was conducted. BP and lipid data were examined over time stratified by disease activity and steroid exposure. Generalized estimating equation regressions were used to find determinants of hypertensive BP and dyslipidemia.

Results: Among 122 children, the prevalence of hypertensive BP at any visit ranged from 17.4% to 57.4%, while dyslipidemia prevalence ranged from 40.0% to 96.2% over a median of 30 months of follow-up. Hypertensive BP was found in 46.2% (116/251) of study visits during active disease compared with 31.0% (84/271) of visits while in remission. Dyslipidemia was present in 88.2% (120/136) of study visits during active disease and in 66.0% (101/153) while in remission. Neither dyslipidemia nor hypertensive BP were significantly different with/without medication exposure (steroids and/or CNI). In regression analysis, male sex and urine protein:creatinine ratio (UPC) were significant determinants of hypertensive BP over time, while eGFR was found to be a determinant of dyslipidemia over time.

Conclusions: Results demonstrate persistent hypertensive BPs and unfavorable lipid profiles in the cNEPTUNE cohort regardless of remission status or concurrent steroid or calcineurin inhibitor treatment.

Keywords: Children; Cholesterol; Hypertension; Nephrotic syndrome; Pediatric.

Abstract

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