Aortic stiffening in children with Nephrotic syndrome

Abstract

Background: Nephrotic syndrome (NS) in children is a chronic glomerular disorder that, beyond its renal implications, poses a significant risk for cardiovascular complications. Early vascular alterations, such as increased aortic stiffness, may signal subclinical cardiovascular dysfunction with long-term consequences.

Objective: This study aimed to evaluate aortic stiffness in children with idiopathic NS compared to age- and sex-matched healthy controls using non-invasive echocardiographic indices.

Methods: A case-control study was conducted at Ali Asghar Pediatric Hospital from 2023 to 2024. Eighty-seven children with idiopathic NS and 87 healthy controls underwent M-mode echocardiographic assessment of the ascending aorta. Aortic systolic and diastolic diameters, along with systolic and diastolic blood pressures, were used to calculate stiffness indices: aortic strain (AS), distensibility (AD), stiffness index beta (ASβ), and pressure strain elastic modulus (PSEM). Data were analyzed using SPSS 23  and a p-value < 0.05 was considered statistically significant in all analyses.

Results: Children with NS had significantly higher systolic and diastolic blood pressures, reduced aortic strain (9.62% vs. 14.77%), decreased distensibility (0.0050 vs. 0.0085), and elevated ASβ and PSEM values (p < 0.001 for all). No significant sex distribution differences were noted. Responders to treatment showed better renal function and lower blood pressure but did not differ significantly in vascular stiffness measures. Positive correlations were found between stiffness parameters and proteinuria, serum creatinine, and anthropometric indices.

Conclusion: Children with NS exhibit early signs of aortic stiffening, even in clinical remission. These findings support incorporating cardiovascular surveillance into long-term NS management to identify at-risk children and initiate early interventions.