Longitudinal analysis of blood pressure and lipids in childhood nephrotic syndrome.
Longitudinal analysis of blood pressure and lipids in childhood nephrotic syndrome.
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儿童肾病综合征血压和血脂的纵向分析。
DOI：
10.1007/s00467-024-06301-z
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发表时间：
2024
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作者：
Carboni,Johnathon;Thomas,Elizabeth;Gipson,DebbieS;Brady,TammyM;Srivastava,Tarak;Selewski,DavidT;Greenbaum,LarryA;Wang,Chia-Shi;Dell,KatherineM;Kaskel,Frederick;Massengill,Susan;Reidy,Kimberly;Tran,CherylL;Trachtman,Howard;
在目前的研究中，纵向血压和血脂测量在新诊断肾病综合征（cNEPTUNE）儿童的NEPTUNE队列中进行了检查。我们假设高血压血压和血脂异常会持续存在于肾病综合征患儿中，无论类固醇治疗效果如何。方法对加入肾病综合征研究网络（cNEPTUNE）的19岁以下新发肾病综合征儿童进行多中心纵向观察分析。随着时间的推移，血压和血脂数据根据疾病活动性和类固醇暴露进行分层检查。使用广义估计方程回归来寻找高血压血压和血脂异常的决定因素。结果122名儿童在随访30个月期间，高血压和血脂异常的患病率分别为17.4% ~ 57.4%和40.0% ~ 96.2%。在活动性疾病期间，46.2%（116/251）的患者出现高血压，而在缓解期，这一比例为31.0%（84/271）。在活动性疾病期间88.2%（120/136）的研究访问中存在血脂异常，在缓解期66.0%（101/153）的研究访问中存在血脂异常。药物暴露（类固醇和/或CNI）前后血脂异常和高血压血压均无显著差异。在回归分析中，男性性别和尿蛋白：肌酐比值（UPC）是高血压血压随时间变化的重要决定因素，而eGFR是血脂异常随时间变化的重要决定因素。结论：结果表明，无论缓解状态或同时使用类固醇或钙调磷酸酶抑制剂治疗，cNEPTUNE队列中存在持续的高血压血压和不利的脂质谱。图形摘要更高分辨率的图形摘要版本可作为补充信息
BackgroundIn 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.MethodsA 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.ResultsAmong 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.ConclusionsResults demonstrate persistent hypertensive BPs and unfavorable lipid profiles in the cNEPTUNE cohort regardless of remission status or concurrent steroid or calcineurin inhibitor treatment.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information