الفهرس 
Nephrotic SyndromeOnly 14 pages are availabe for public view
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Abstract
Nephrotic Syndrome (NS) is a common chronic pediatric disorder, that is still representing a therapeutic and physiopathological challenge, NS is associated with increased risk of cardiovascular complications. The cardiovascular complications in NS include pulmonary hypertension, pulmonary embolism, cardiomyopathy and atherosclerosis.
The present study aimed to assess coronary flow reserve and pulmonary pressure in patients with Nephrotic syndrome during relapse and after remission and its correlation with lipid profile, systemic blood pressure and duration of illness.
This prospective follow up study was conducted in the Nephrology Clinic and Children’s Hospital, Ain Shams University in the period from June 2011 to June 2012.
This study was coducted on 30 NS patients, who were divided into 3 groups:
Group I: Included 10 patients [7 males (70%) and 3 females (30%)] with newly diagnosed nephrotic syndrome (NDNS) in activity and after remission, their ages ranged from 1-5 years (mean=3.5 ±1.71).
Group II: Included 10 patients [6 males (60%) and 4 females (40%)], with frequent relapsing nephrotic syndrome (FRNS) in relapse and after remission, their ages ranged from 3-7 years (mean=5 ±1.46).
Group III: Included 10 patients [7 males (70%) and 3 females (30%)] with steroid resistant nephrotic syndrome (SRNS), their ages ranged from 3.5-8 years (mean=5.5 ±1.92).
Those groups were compared to 30 age and sex matched apparently healthy children as a control group (group IV).
All patients were subjected to history taking, clinical examination, routine investigations including CBC, serum albumin, ESR, CRP and lipid profile (Total cholesterol, TG, LDL, HDL). Lipid profile was withdrawn after 12 hours fasting.
They were also subjected to two dimensional, M-mode, pulsed, continuous wave and colour doppler echocardiographic examinations for assessment of cardiac systolic function, detection of any chamber enlargement, valvular abnormality and measuring pulmonary pressure from tricuspid regurgitation jet velocity (TRJV).
Coronary flow reserve was assessed by color Doppler echocardiography, by recording baseline spectral doppler signals in the left-anterior descending (LAD), then adenosine was administered on a dose (140 µg/ kg/ min IV) for 2 minutes to record Doppler signals during hyperemic conditions. CFVR was then expressed as the ratio of coronary flow velocity under maximal vasodilatation to coronary flow velocity at rest.
The present study revealed the following results :
Coronary flow reserve (CFR) was statistically significantly reduced in steroid resistant NS patients (100%) and frequent relapsers NS patients in relapse (60%) than control, but no significant difference was detected in CFR between Newly diagnosed NS patients in activity and control.
During activity of the disease, both newly diagnosed NS and frequent relapser NS patients had a significantly lower CFR than in remission.
During remission of the disease, no significant difference was noted as regards CFR between newly diagnosed NS patients and control, but frequent relapsers NS patients (60%) still had a significantly reduced CFR when compared to control.
All steroid resistant NS patients (100%) had reduced CFR, steroid resistant NS patients had significantly lower CFR when compared to newly diagnosed and frequent relapsers NS patients in activity.
As regards pulmonary artery pressure (PAP), it was significantly increased in newly diagnosed, frequent relapsers NS patients in activity (50%, 80% respectively) and steroid resistant NS patients (100%) when compared to control.
During activity of the disease, a statistically significant increase in pulmonary artery pressure was noted in newly diagnosed patients and frequent relapser NS patients when compared to patients after remission.
During remission, no significant difference in pulmonary artery pressure between newly diagnosed NS patients and control, but frequent relapsers NS patients (30%) had statistically significant increase in pulmonary pressure when compared to control.
All steroid resistant NS patients (100%) had pulmonary hypertension, steroid resistant NS patients had a significantly higher pulmonary pressure when compared to newly diagnosed and frequent relapsers NS patients in activity.
A statistically significant negative correlation was found between CFR and (duration of NS, systemic blood pressure , total cholesterol, ESR and CRP).
A statistically significant positive correlation was found between pulmonary pressure and (duration of NS, systemic blood pressure , total cholesterol, ESR and CRP).