Echocardiographic Findings in Children with Nephrotic Syndrome Compared with the Healthy Children

Abstract

Background: Nephrotic syndrome (NS) is a prevalent condition in childhood that poses significant risks, with cardiovascular events being the leading cause of morbidity and mortality in this population. Given the critical nature of cardiovascular health in NS patients, this study aims to examine echocardiographic data in affected children. Objectives: Given the critical nature of cardiovascular health in NS patients, the present study aims to examine echocardiographic data in affected children. Methods: This case-control study involved children with idiopathic NS who were referred to Ali Ibn Abi Taleb Hospital, Zahedan, Iran. Inclusion criteria were being under 18 years of age without congenital kidney disease, as well as having provided consent to participate in the study. Exclusion criteria were severe systemic diseases and secondary NS. Comprehensive echocardiographic and laboratory parameters were gathered from both patients and matched healthy controls. Biochemical assessments, including serum albumin (Alb), cholesterol (Cho), urea, and creatinine (Cr), were evaluated using spectrophotometry. The echocardiographic parameters such as Myocardial Performance Index (MPI), E/A ratio, ejection fraction (EF), and ventricular dimensions were obtained through M-mode and 2D echocardiography. Statistical analyses were performed using SPSS version 23, employing appropriate parametric and non-parametric tests, with a significance level set at P < 0.05. Results: The analysis revealed statistically significant differences in various echocardiographic variables between patients with NS and healthy subjects. These variables included the early-to-late flow velocity ratio of tricuspid (P = 0.043) and mitral (P < 0.001) valves, early flow velocity of tricuspid (P < 0.001) and mitral (P < 0.001) valves, left ventricular end-systolic (LVSD) dimension (P < 0.001), ejection time (ET) of the right (P = 0.004) and left (P = 0.008) ventricle, EF (P < 0.001), MPI of the left (P = 0.002) and right (P = 0.011) ventricles, and fractional shortening (FS) (P < 0.001). In contrast, other variables, including left ventricular end-diastolic dimension (P = 0.093), peak A velocity of the right (P = 0.232) and left (P = 0.655) did not show statistically significant differences between the groups. No significant correlations were observed between biochemical parameters (serum Alb, Cr, Cho, and urine protein-creatinine ratio) and echocardiographic parameters. Conclusions: It was concluded that children with NS may experience significant heart problems affecting both the left and right sides of the heart, even when common blood tests show no warning signs. Because these heart issues can develop quietly, without any noticeable symptoms, early heart checkups using echocardiography are strongly recommended.