Clinical analysis of changes of ambulatory blood pressure in children with primary nephrotic syndrome

doi:10.16150/j.1671-2870.2022.05.011

Abstract

Abstract:

Objective: To explore the characteristics of the changes of ambulatory blood pressure (ABP) in the children with primary nephrotic syndrome (PNS). Methods: A total of 106 PNS children′s reports of 24-hour ambulatory blood pressure in Shanghai Children′s Medical Center were analyzed retrospectively. Results: The incidence of hypertension in PNS children was 60.4% (64/106), and 58.5% (62/106) children had nighttime hypertension, and 16.0% (17/106） children had daytime hypertension. The incidence of hypertension at night was higher than that in daytime(P<0.05). The loads of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at night were higher than those at the daytime (SBP 52.32%±36.87% vs 19.41%±19.70%, DBP 39.22%±34.69% vs 18.42%±21.66%, P<0.05). Among 106 children, 92(86.8%) had abnormal circadian rhythms in SBP and/or DBP ambulatory blood pressure, and most of them were non-dippers (68.9%). SBP rhythm was more likely to be abnormal than DBP rhythm (79.2% vs 65.1%, P=0.022). There was a statistical difference in the rate of blood pressure decline between SBP and DBP at night [SBP (3.52%±6.97%) vs DBP (7.78%±9.18%), P<0.001]. The incidence of white-coat hypertension was 12.3%, and the incidence of masked hypertension was 14.2%. Conclusions: PNS children are prone to nocturnal hypertension and abnormal circadian rhythm, especially SBP. 24 h ambulatory blood pressure is conducive to collecting blood pressure change information and to guide the rational use of antihypertensive drugs for PNS children.

Key words: Ambulatory blood pressure, Pediatric, Primary nephrotic syndrome

CLC Number:

R544

SHEN Xiaoyu, SHA Sha, YIN Lei, ZHOU Wei, LUO Ningxin, WANG Xuefeng. Clinical analysis of changes of ambulatory blood pressure in children with primary nephrotic syndrome[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(05): 613-618.

Figures/Tables 2

References 31

[1]	Warady BA, Chadha V. Chronic kidney disease in children: the global perspective[J]. Pediatr Nephrol, 2007 Dec; 22(12):1999-2009. doi: 10.1007/s00467-006-0410-1 pmid: 17310363
[2]	Siomou E, Stefanidis CJ. FGF-23 in children with CKD: a new player in the development of CKD-mineral and bone disorder. Nephrol Dial Transplant, 2012, 27(12):4259-4262. doi: 10.1093/ndt/gfs315 URL
[3]	Flynn JT, Mitsnefes M, Pierce C, et al. Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study[J]. Hypertension, 2008, 52(4):631-637. doi: 10.1161/HYPERTENSIONAHA.108.110635 pmid: 18725579
[4]	Kontchou LM, Liccioli G, Pela I. Blood pressure in children with minimal change nephrotic syndrome during oedema and after steroid therapy: the influence of fami-lial essential hypertension[J]. Kidney Blood Press Res, 2009, 32(4):258-262. doi: 10.1159/000238823 URL
[5]	Kyrieleis HA, Löwik MM, Pronk I, et al. Long-term outcome of biopsy-proven, frequently relapsing minimal-change nephrotic syndrome in children[J]. Clin J Am Soc Nephrol, 2009, 4(10):1593-1600. doi: 10.2215/CJN.05691108 URL
[6]	Sarkar S, Sinha A, Lakshmy R, et al. Ambulatory blood pressure monitoring in frequently relapsing nephrotic syndrome[J]. Indian J Pediatr, 2017, 84(1):31-35. doi: 10.1007/s12098-016-2207-y pmid: 27538980
[7]	徐志泉, 易著文, 党西强, 等. 原发性肾病综合征儿童交感活性与24 h动态血压的关系[J]. 中南大学学报(医学版), 2010, 35(7):693-698.
	Xu ZQ, Yi ZW, Dang XQ, et al. Sympathetic nervous system level and ambulatory blood pressure in children with primary nephrotic syndrome[J]. J Cent South Univ(Med Sci), 2010, 35(7):693-698.
[8]	中华医学会儿科学分会肾脏病学组. 小儿肾小球疾病的临床分类、诊断及治疗[J]. 中华儿科杂志, 2001, 39(12):746-749.
	Nephrology Group, Pediatric Society, Chinese Medical Association. Clinical classification,diagnosis and treatment of glomerular diseases in children[J]. Chin J Pediatr, 2001, 39(12):746-749.
[9]	Stergiou GS, Alpert B, Mieke S, et al. A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement[J]. J Hypertens, 2018, 36(3):472-478. doi: 10.1097/HJH.0000000000001634 pmid: 29384983
[10]	中国高血压联盟《动态血压监测指南》委员会. 2020中国动态血压监测指南[J]. 中国循环杂志, 2021, 36(4):313-328.
	China Hypertension Alliance Guidelines for Ambulatory Blood Pressure Monitoring Committee. 2020 Chinese Hypertension League Guidelines on Ambulatory Blood Pressure Monitoring[J]. Chin Circ J, 2021, 36(4):313-328.
[11]	Soergel M, Kirschstein M, Busch C, et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects[J]. J Pediatr, 1997, 130(2):178-184. doi: 10.1016/S0022-3476(97)70340-8 URL
[12]	Flynn JT, Daniels SR, Hayman LL, et al. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association[J]. Hypertension, 2014, 63(5):1116-1135. doi: 10.1161/HYP.0000000000000007 pmid: 24591341
[13]	范晖, 闫银坤, 米杰. 中国3-17岁儿童性别、年龄别和身高别血压参照标准[J]. 中华高血压杂志, 2017, 25(5):428-435.
	Fan H, Yan YK, Mi J. Updating blood pressure refe-rences for Chinese children aged 3-17 years[J]. Chin J Hypertens, 2017, 25(5):428-435.
[14]	Mitsnefes M, Ho PL, McEnery PT. Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study(NAPRTCS)[J]. J Am Soc Nephrol, 2003, 14(10):2618-2622. pmid: 14514740
[16]	徐志泉, 易著文, 党西强, 等. 原发性肾病综合征患儿动态血压与肾损害的关系[J]. 临床儿科杂志, 2010, 28(10):955-959.
	Xu ZQ, Yi ZW, Dang XQ, et al. Ambulatory blood pressure monitoring in children with primary nephrotic syndrome and its relationship with renal damage[J]. J Clin Pediatr, 2010, 28(10):955-959.
[17]	Li X, Li J, Liu K, et al. Association between sleep disorders and morning blood pressure in hypertensive patients[J]. Clin Exp Hypertens, 2018, 40(4):337-343. doi: 10.1080/10641963.2017.1377217 URL
[18]	李俊伟, 薛文生, 王红宇. 单纯夜间高血压和全天高血压病人靶器官损害与预后的比较[J]. 中西医结合心脑血管病杂志, 2019, 17(14):2139-2143.
	Li JW, Xue WS, Wang HY, et al. Comparison of target organ damage and prognosis between patients with nocturnal hypertension and all-day hypertension[J]. Chin J Integr Med Cardio-Cerebrovasc Dis, 2019, 17(14):2139-2143.
[19]	程文荣, 程虹, 张瑞雨, 等. 昼夜血压节律改变对IgA肾病伴高血压患者临床及病理的影响[J]. 中华肾脏病杂志, 2018, 34(12):881-886. doi: 10.3760/cma.j.issn.1001-7097.2018.12.001
	Cheng WR, Cheng H, Zhang RY, et al. Clinical and pathological significance of circadian blood pressure rhythm change in IgA nephropathy patients with hypertension[J]. Chin J Nephrol, 2018, 34(12):881-886. doi: 10.3760/cma.j.issn.1001-7097.2018.12.001
[20]	Ohkubo T, Kikuya M, Metoki H, et al. Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study[J]. J Am Coll Cardiol, 2005, 46(3):508-515. doi: 10.1016/j.jacc.2005.03.070 pmid: 16053966
[21]	朱音, 徐虹, 田宏, 等. 动态血压监测在儿童肾脏疾病中的临床研究[J]. 中华儿科杂志, 2008, 46(5):374-377.
	Zhu Y, Xu H, Tian H, et al. Ambulatory blood pressure monitoring in pediatric patients with kidney diseases[J]. Chin J Pediatr, 2008, 46(5):374-377.
[22]	梁田. 动态血压模式的研究进展及临床应用[J]. 中国心血管病研究, 2012, 10(1):69-73.
	Liang T. Advance and clinical application of ambulatory blood pressure pattern[J]. Chin J Cardiovasc Res, 2012, 10(1):69-73.
[23]	Yang WY, Melgarejo JD, Thijs L, et al. Association of office and ambulatory blood pressure with mortality and cardiovascular outcomes[J]. JAMA, 2019, 322(5):409-420. doi: 10.1001/jama.2019.9811 URL
[24]	孙红喜, 陈莉明, 常宝成, 等. 动态血压节律变化在糖尿病肾病早期诊断中的价值[J]. 中华内分泌代谢杂志, 2013, 29(5):368-373.
	Sun HX, Chen LM, Chang BC, et al. Value of variation in circadian rhythm of blood pressure for early diagnosis of diabetic nephropathy[J]. Chin J Endocrinol Metab, 2013, 29(5):368-373.
[25]	Asayama K, Thijs L, Li Y, et al. Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population[J]. Hypertension. 2014 Nov; 64(5):935-42. doi: 10.1161/HYPERTENSIONAHA.114.03614 pmid: 25135185
[26]	Brguljan-Hitij J, Thijs L, Li Y, et al. Risk stratification by ambulatory blood pressure monitoring across JNC classes of conventional blood pressure[J]. Am J Hypertens, 2014, 27(7):956-965. doi: 10.1093/ajh/hpu002 pmid: 24572704
[27]	Matsuoka S, Awazu M. Masked hypertension in children and young adults[J]. Pediatr Nephrol, 2004, 19(6):651-654. pmid: 15071772
[28]	Matsuoka S, Kawamura K, Honda M, et al. White coat effect and white coat hypertension in pediatric patients[J]. Pediatr Nephrol, 2002, 17(11):950-953. pmid: 12432440
[29]	涂娟, 陈朝英, 李华荣, 等. 儿童肾脏疾病170例动态血压监测的临床分析[J]. 中华实用儿科临床杂志, 2020, 35(13):992-995.
	Tu J, Chen CY, Li HR, et al. Clinical analysis of ambulatory blood pressure monitoring in 170 children with kidney diseases[J]. Chin J Appl Clin Pediatr, 2020, 35(13):992-995.
[30]	Stabouli S, Kotsis V, Toumanidis S, et al. White-coat and masked hypertension in children: association with targeto-rgan damage[J]. Pediatr Nephrol, 2005, 20(8):1151-1155. pmid: 15947982
[31]	Mitsnefes M, Flynn J, Cohn S, et al. Masked hypertension associates with left ventricular hypertrophy in children with CKD[J]. J Am Soc Nephrol, 2010, 21(1):137-144. doi: 10.1681/ASN.2009060609 pmid: 19917781

分类	诊室血压	平均动态血压	血压负荷（%）
正常血压	<第95百分位	<第95百分位	<25
白大衣高血压	>第95百分位	<第95百分位	<25
隐匿性高血压	<第95百分位	>第95百分位	>25
高血压前期	>第95百分位	<第95百分位	25~50
动态高血压	>第95百分位	>第95百分位	25~50
严重动态高血压	>第95百分位	>第95百分位	>50

时段	SBP负荷（%）	DBP负荷（%）	t值	P值
24 h	31.52±22.84	25.54±23.93	1.861	0.064
日间	19.41±19.70	18.42±21.66	0.350	0.726
夜间	52.32±36.87	39.22±34.69	2.665	0.008
t值^*	-8.103	-5.236
P值^*	<0.001	<0.001