7/25/2019 2015-03-10_10-41-52-AMMD 49

1/4

7/25/2019 2015-03-10_10-41-52-AMMD 49

2/4

BMR Medicine

MD 49|Volume 1|Issue 1|2015

2

INTRODUCTION

Childhood nephrotic syndrome (NS) is a chronicglomerular disease, characterized by minimal changedisease in the majority of cases [1]. Hyperlipidemia is animportant characteristic of idiopathic nephrotic syndrome

in children and is usually observed during the active phaseof the disease and disappears with the resolution of theproteinuria [2]. The persistence and severity of lipidchanges in serum correlates well with the duration andfrequency of the relapses, even during the remission,which leads to increased risk of atherosclerosis in later lifeand the development of progressive renal injury[3].Henceclose monitoring of lipid levels during remission ofnephrotic syndrome is necessary to select high riskpatients. It has been noted that certain factors like diet,malnutrition, genetic traits are known to alter thefrequency and severity of lipid pattern. The Indian patienthas a different dietary, constitutional and genetic

background. Hence we undertook a study to determine thespectrum of lipid abnormalities (serum cholesterol, serumtriglycerides, LDL, VLDL and HDL) in nephroticsyndrome at the onset and during remission.

MATERIALS AND METHODS

It is a prospective study done in Basaveshwara MedicalCollege and Hospital, Chitradurga during period of June2010 to October 2013. 50 children in the age group of 2-12years with typical features of nephrotic syndrome wereincluded in the study. Children with prior history diabetesmellitus, hypothyroidism, familial hypercholesterolemia,steroid resistance at 4 weeks of steroid therapy, features

which make minimal change disease less likely wereexcluded from study. Ethical clearance was sorted frominstitute ethical clearance committee. Written informedconsent was taken from the subjects prior to enrollment ofstudy. Data was collected by using pre-tested proformameeting the objectives of the study.

Children with edema, low serum albumin (

7/25/2019 2015-03-10_10-41-52-AMMD 49

3/4

BMR Medicine

MD 49|Volume 1|Issue 1|2015

3

Table 1 shows that there was statistically significant increase in serum cholesterol, triglycerides, LDL and VLDL innephrotic syndrome patients when compared to controls (p

7/25/2019 2015-03-10_10-41-52-AMMD 49

4/4

BMR Medicine

MD 49|Volume 1|Issue 1|2015

4

frequently relapsing children [2]. Mahmud S et alobserved that children with frequently relapsing nephroticsyndrome have prolonged periods of hypercholesterolemiaand concluded that serum cholesterol may be regardedas predictor of relapse in childhood idiopathic nephroticsyndrome[19].

Relation between serum albumin and serum lipids

In our study, we observed an inverse correlation betweenalbumin and cholesterol. The correlation was statisticallyhighly significant (p=0.000). Krishnaswamy D et al foundthe correlation is not statistically significant [20].ThomasEM et al found inverse correlation between serumcholesterol and albumin [21]. It is due to hepaticlipoprotein synthesis is stimulated in response tohypoalbuminemia, low oncotic pressure and urinaryalbumin loss.

CONCLUSION

The present study shows that in nephrotic syndrome, thereis generalized hyperlipidemia (except HDL). This wassignificantly higher in relapse cases compared to firstepisode. Lipid profiles reaches normal during remission infirst episode, whereas in relapse cases it was significantlyhigher even during remission.

Close monitoring of lipid levels during the remission ofthe nephritic syndrome especially in those with frequentrelapses, is necessary to select the high risk patients. Thiswill help in preventing the development of atherosclerosisand chronic renal failure. Prospective controlled studies inchildren evaluating efficacy and safety of lipid loweringdrugs are needed.

REFERENCES

[1]

Bagga A, Mantan M. Nephrotic syndrome in children.Indian J Med Res. 2005;122(1):13-28.

[2]

Merouani A, Levy E, Mongeau JG, Robitaille P, LambertM, Delvin EE. Hyperlipidemic profiles during remission inchildhood idiopathic nephrotic syndrome. Clin Biochem.2003;36(7):571-4.

[3]

Wheeler DC, Bernard DB. Lipid abnormalities in thenephrotic syndrome: causes, consequences, and treatment.Am J Kidney Dis. 1994;23(3):331-46.

[4]

Shakir FK, Audilet D, Drake AJ III, Shakir KMM. A rapidprotein determination by modification of the Lowry

procedure. Anal Biochem. 1994;216:232-3.[5]

Wootton I.D.P (1964). Microanalysis of medicalbiochemistry: Fourth edition.

[6]

Harold Varley, Alan H Gowenlock, Mauriee Bell (1991).Practical Clinical Biochemistry. Vol 1: Fifth Edition.

[7]

Searcy RL, Bergquist LM. A new color reaction for thequantitation of serum Cholesterol. Clin Chim Acta.1960;5:192-9.

[8]

Margret J Fletcher. A colorimetric method for estimatingserum triglycerides. Clin Chem Acta;22:393-7.

[9]

John Charles Marshell Stewart: Colorimetric determinationof Phospholipids with ammonium ferrothocyanate, AnalBiochem.1980;104:10-4.

[10]

Appel GB, Blum CB, Chien S, Kunis CL, Appel AS. Thehyperlipidemia of the nephrotic syndrome. Relation to

plasma albumin concentration, oncotic pressure, andviscosity. The New England journal of medicine.1985;312(24):1544-8.

[11]

Joven J, Villabona C, Vilella E, Masana L, Alberti R, VallesM. Abnormalities of lipoprotein metabolism in patients withthe nephrotic syndrome. The New England journal ofmedicine. 1990;323(9):579-84.

[12]

Ohta T, Matsuda I. Lipid and apolipoprotein levels inpatients with nephrotic syndrome. Clinica chimica acta;International journal of clinical chemistry. 1981;117(2):133-43.

[13]

Alexander JH, Schapel GJ, Edwards KD. Increased

incidence of coronary heart disease associated withcombined elevation of serum triglyceride and cholesterolconcentrations in the nephrotic syndrome in man. TheMedical journal of Australia. 1974;2(4):119-22.

[14]

Arije A, Erasmus RT, Anjorin SA. Plasma lipids andlipoproteins cholesterol distributions in nephrotic syndromepatients during short term steroid treatment. Cent Afr J Med.1993;39(10): 211-5.

[15]

Milne M (1976). Biochemical disorders in human disease.2nd ed. London: Churchill Ltd: 211.

[16]

Dnyanesh DK, Dnyanesh S, Shenoy V. A study of serumlipids in nephrotic syndrome in children. IOSR-JDMS.2014;13(3):01-06.

[17]

Jensen H. Plasma protein and lipid pattern in the nephrotic

syndrome. Acta medica Scandinavica. 1967;182(4):465-73.

[18]

Joven J, Rubies-Prat J, Espinel E, Ras MR, Piera L. High-density lipoproteins in untreated idiopathic nephroticsyndrome without renal failure. Nephrology, dialysis,transplantation: official publication of the European Dialysisand Transplant Association - European Renal Association.1987;2(3):149-53.

[19]

Mahmud S, Jahan S, Hossain MM. Hyperlipidemia inchildhood idiopathic nephritic syndrome during initialremission and relapse. Mymensingh Med J. 2011;20(3):402-6.

[20]

Krishnaswamy D, Indumati V, Sathishkumar D, Vijay V,Maharudra.Shekanawar, Amareshwara.Maligi et al. Serumproteins, initial and follow up lipid profile in children withnephritic syndrome. International journal of Applied Biologyand pharmaceutical technology. 2011;2(3):59-64.

[21]

Thomas EM, Rosenblum AH, Lander HB, Fisher R.Relationship between blood lipid and blood protein levels innephrotic syndrome, Amer J Dis. Child 1951;81(2):207-14.