Cardiac Functions in Children with Steroid Sensitive Nephrotic Syndrome

Background: The aim of the present study was to evaluate the presence of cardiac systolic and diastolic dysfunction in pediatric patients with steroid sensitive nephrotic syndrome (NS).

Methods: The study population consisted of 19 patients with debut-relapse of NS aged 1-18 years and 30 sex and age-matched healthy controls. Blood, urine samples, two M-mode Conventional echocardiogram and Tissue Doppler velocity imaging (TDI) were evaluated in both attack and remission periods RESULTS: With regard to conventional pulse wave Doppler (cPWD), steroid sensitive NS patients (both in debut/relapse and in remission periods) had a higher peak of late diastolic flow velocities (A peak) and patients in debut/relapse had a lower E/A ratio than control group indicating diastolic dysfunction (overall p=0.003 and p=0.006, respectively). Based on TDI echocardiography results, patients in debut/relapse had a higher A’ and a lower E’/A’ ratio (overall p<0.001 and p=0.001, respectively). There was also a significant difference in the cPWD E/TDI E’ ratio between the patients showing an increased cPWD E/TDI E’ ratio in remission compared to in debut/relapse period (p=0.09). The albumin levels were positively correlated with E’/A’ and E/ E’ ratio (r=0.609; p=0.007, r=0.472; p=0.041 respectively).

Conclusions: Systolic cardiac functions are preserved but diastolic functions are affected in steroid sensitive NS patients both in debut/relapse and in remission periods in a relatively short time period. The persistence of LV dysfunction during remission period requires special attention during the follow-up period for early detection of cardiac abnormalities.