The risk of cardiovascular disease in adults who have had childhood nephrotic syndrome

Abstract

While increased risk of cardiovascular disease (CVD) in patients with hyperlipidemia, chronic kidney disease (CKD), or end-stage renal disease (ESRD) is well documented, transient hyperlipidemia or intermittent renal disease as a consequence of relapsing nephrotic syndrome (NS) has not been studied. To investigate this enigma, 62 patients, between 25 and 53 years of age, who had steroid-responsive/dependent NS during childhood, were identified from the records of the Division of Pediatric Nephrology at Yale School of Medicine. Forty patients were located and contacted to ascertain symptoms or occurrences of CVD via a telephone interview. At the time of follow-up, 23-46 years after cessation of NS, none of these patients had ESRD or CKD. Three patients had experienced a myocardial infarction (MI): a 32-year-old male with a family history of CVD; a 41-year-old male with a history of heavy smoking, hypertension, diabetes mellitus, and elevated cholesterol; a 31-year-old male after a cocaine overdose. The occurrence of events (8%) and mortality from CVD (none) in this cohort of patients is comparable to patients of a similar age in the general population and is lower than that of patients of the same age who are on dialysis. The data suggest that relapsing NS during childhood does not place patients at increased risk for CVD mortality or morbidity compared with the general population. Consequently, it would appear that factors related to persistent proteinuria or renal insufficiency, rather than transient proteinuria and renal disease, contribute to the CVD documented in patients with CKD or ESRD.

Alterations of Lipid Metabolism in Chronic Nephropathies: Mechanisms, Diagnosis and Treatment

“…In opposition, despite the above lipoprotein changes, Lechner et al [24] have not shown a consistent relationship between NS, in the absence of uremia, and an increased risk of CVD.…”

The Treatment of Minimal Change Disease in Adults

“…One study of 40 adults who had relapsing NS as children did not show a higher incidence of cardiovascular disease, implying that longterm cardiovascular risk was not increased by intermittent hyperlipidemia during nephrotic relapses in childhood, although this study was small and no firm conclusion can be derived from the data. 89 The use of renin-angiotensin-aldosterone blockers and statins may be considered on a case-by-case basis in MCD adults, particularly those patients with hypertension.…”

Markers of Endothelial Dysfunction in Children with Idiopathic Nephrotic Syndrome

“…However, in children, the role of idiopathic nephrotic syndrome (INS) in the development of atherosclerosis has been unclear [4]. INS is associated with the presence of several classical risk factors for cardiovascular disease, including obesity, hypercholesterolemia, increased thrombinogenesis, impaired fibrinolysis, enhanced platelet activation, oxidative stress, insulin resistance, immunological dysregulation and subclinical inflammation [5, 6].…”