Key result
Children with active nephrotic syndrome had significantly higher levels of endothelial dysfunction biomarkers (vWF, PAI-1, and sTM) compared to controls (P < 0.0001).
Why the study?
Impaired endothelial function is a precursor of atherosclerosis leading to cardiovascular adverse events, prompting evaluation of endothelial dysfunction markers in children with SRNS and FRNS/SDNS.
Do children with frequently relapsing/steroid-dependent or steroid-resistant nephrotic syndrome have elevated biomarkers of endothelial dysfunction compared to healthy controls?
Cross-Sectional (n=54)
Do children with frequently relapsing/steroid-dependent or steroid-resistant nephrotic syndrome have elevated biomarkers of endothelial dysfunction compared to healthy controls?
p-value: p=< 0.0001
Children with frequently relapsing/steroid-dependent and steroid-resistant nephrotic syndrome exhibit significant endothelial dysfunction, a precursor to atherosclerosis, across various stages of the disease.
Potential endothelial role in pediatric nephrotic syndrome complications; hypothesis-generating cross-sectional data requiring prospective validation.
Background: Impaired endothelial function is a precursor of the atherosclerotic process leading to cardiovascular adverse events. This study evaluated endothelial dysfunction using endothelial markers in children with steroid-resistant NS (SRNS) and frequently relapsing or steroid-dependent NS (FRNS/SDNS). Methods: This was a cross-sectional study with short-term follow up. Thirty-five patients with nephrotic syndrome (NS), aged 1–18 years, including 19 with frequent relapses or steroid-dependent NS (FRNS/SDNS) and 16 with steroid resistant NS (SRNS), and 19 age- and gender-matched controls, were enrolled for the study. Soluble thrombomodulin (sTM), plasminogen activator inhibitor 1 (PAI-1), and von Willebrand factor (vWF) levels were measured in patients with FRNS/SDNS in relapse and after 6 months of steroid-induced remission, at diagnosis in SRNS, and in controls. Results: Levels of vWF, PAI-1, and sTM were significantly higher than controls in patients with active NS (FRNS/SDNS in relapse or SRNS; P < 0.0001). Patients with FRNS/SDNS had significantly elevated vWF levels, compared to controls, even after 6 months of corticosteroid therapy. Levels of vWF were significantly higher for patients with recently diagnosed SRNS than relapse of FRNS/SDNS (P < 0.0001). Conclusion: Children with FRNS/SDNS and SRNS have significant endothelial dysfunction in all stages of disease in varying severity. It is unclear whether persistently elevated biomarkers of endothelial dysfunction contribute to future atherosclerotic events in patients with NS.
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Saha et al. (2020) conducted a cross-sectional in Nephrotic syndrome (n=54). Active nephrotic syndrome (FRNS/SDNS or SRNS) vs. Age- and gender-matched controls was evaluated on Levels of von Willebrand factor (vWF), plasminogen activator inhibitor 1 (PAI-1), and soluble thrombomodulin (sTM) (p=< 0.0001). Children with active nephrotic syndrome had significantly higher levels of endothelial dysfunction biomarkers (vWF, PAI-1, and sTM) compared to controls (P < 0.0001).
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