Approach to the Evaluation of Clinical and Metabolic Factors Interaction in Children With Nephrotic Syndrome

Nephrotic syndrome (NS) is the most common glomerular kidney disease in childhood.The limited success of existing therapeutic strategies in slowing the progression ofchronic kidney disease requires the study of new ways of assessing and interpreting levelsof chronic intracellular hypoxia relative to basic clinical data and indicators of kidneyfunction in children with NS.The purpose of the work – to investigate the main clinical and laboratory indicators,the state of the transcription factor and the marker of intracellular hypoxia HIF-1alfaas possible factors of cluster division and stratification according to the severity ofdamage in children with NS; to evaluate the peculiarities of the relationship of the abovementioned markers in the selected cluster groups of children.Materials and methods. 37 children with hormone- sensitive NS were examined. Theintracellular hypoxia marker HIF-1alfa, creatinine, cholesterol in blood plasma samples,general blood analysis data, glomerular filtration rate (GFR), proteinuria level weredetermined. For multiple comparisons and testing the significance of differences, theANOVA method was used followed by the Kruskal- Wallis post-hoc test. The correlationbetween the studied factors was determined by the Pearson test. GraphPad Prism 9.0Software was used. Two-stage cluster analysis was performed using Statistica 10.0software. P values <0.05 were considered statistically significant.The results. Four cluster groups of children with NS were formed, which differed in thelevel of HIF-1alfa. It was established that the increase of HIF-1 alpha to 189.2±1.37 units.associated with a decrease in GFR. Further increase of HIF-1alfa to 200.2±3.02 units.associated with a decrease in GFR, an increase in inflammatory status, and a decreasein cholesterol. HIF-1alfa at the level of 214.4±1.81 units. associated with the mostsignificant decrease in GFR, level of proteinuria, inflammatory phenotype.Conclusion. The increase of HIF-1 alpha to 189.2±1.37 units and more in children withNS can be used as a starting point for specific antihypoxic therapeutic measures.