Abstract

Background: Nephrotic syndrome is a collection of clinical findings due to kidney damage. This includes protein in urine, low blood albumin levels, high blood lipids, and significant edema. The main cause of hyperlipidemia in patients with NS is probably increased hepatic lipogenesis, a non-specific reaction to falling oncotic pressure secondary to hypoalbuminemia. Hyperlipidemia is usually observed during the active phase of the disease and disappears with resolution of proteinuria. However, it may persist in some cases, leading to increased risk of atherosclerosis in later life and development of progressive renal injury. The current study was carried out to evaluate dyslipidemia in children with nephrotic syndrome.
Methods: This prospective cohort study was carried out at outpatient and inpatient units of Department of Pediatrics, JLN Medical College, Ajmer, Rajasthan, India during January 2020 to December 2020. A total of 60 consecutive children aged between one year and 18 years with newly diagnosed nephrotic syndrome or presenting with relapse of the disease. All patients were routinely monitored with daily weight, BP, abdominal girth, intake/output chart and urine albumin. Patients previously diagnosed with nephrotic syndrome with relapse were also admitted. Serum lipid profile was done by standard methods at three points of time: during disease activity, after attainment of remission and two weeks after completion of steroid therapy in steroid responsive nephrotic syndrome.
Results: Lipid parameters including mean total cholesterol, Triglyceride, LDL and VLDL were elevated at admission and these levels reduced significantly at remission and at completion of steroid therapy (All p values<0.001). There was significant elevation of mean total cholesterol level in case of relapse as compared to the first episode of nephrotic syndrome (p=0.048), however, LDL, VLDL and HDL were not significantly different. There was significant elevation of total cholesterol level at admission in subsequent relapses as compared to first episode of nephrotic syndrome (p=0.01).
Conclusion: In children with nephrotic syndrome, lipid parameters including mean total cholesterol, Triglyceride, LDL and VLDL were elevated at admission and these levels reduced significantly at remission and at completion of steroid therapy. Total cholesterol level was significantly elevated in children with relapse as compared to those with first episode of nephrotic syndrome.