Journal of Diagnostics Concepts & Practice >

2024 , Vol. 23 >Issue 05: 531 - 536

DOI: https://doi.org/10.16150/j.1671-2870.2024.05.010

Original articles

Clinical study of ambulatory blood pressure changes in children with stage Ⅰ-Ⅱ chronic kidney disease combined with proteinuria

  • SHEN Xiaoyu ,
  • SHA Sha ,
  • YIN Lei ,
  • ZHOU Wei ,
  • MAO Youying ,
  • WANG Zhangjuan ,
  • SUN Yan ,
  • WU Yan
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  • Nephrotic Department, b.International Medical Department, c. Neonatal Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University，Shanghai 200127,China；

Received date: 2024-04-12

  Accepted date: 2024-10-08

  Online published: 2025-02-25

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Abstract

Objective To investigate ambulatory blood pressure changes in children with stage Ⅰ-Ⅱ chronic kidney disease (CKD) combined with proteinuria. Methods Ambulatory blood pressure (ABP) reports of 150 consecutive cases with stage Ⅰ-Ⅱ CKD combined with proteinuria in our hospital from January 2019 to October 2022 were analyzed retrospectively to find out the incidence of hypertension, the clinical characteristics of the rhythm of ABP among various renal diseases. Age, gender, body mass index, CKD stage, proteinuria and steroids were compared between ambulatory hypertension group and normal ambulatory blood pressure group. Results The incidence of white coat and masked hypertension was 2.67% and 12.00% respectively. The incidence of ambulatory hypertension was high (ambulatory hypertension 14% vs clinic hypertension 7.33%); 118 patients(78.67%) with stage Ⅰ-Ⅱ CKD combined with proteinuria have demonstrated abnormal ABP rhythms, but no statistically significant differences were observed among the various renal diseases (P>0.05). There was a significant difference in the incidence of clinic hypertension between the massive proteinuria and non-massive proteinuria groups (P<0.05), while no statistical significance was found in ABP rhythm (P>0.05). There were no significant differences in age, gender, body mass index, CKD stage and steroids between the ambulatory hypertension group and the normal ambulatory blood pressure group (P>0.05). However, the incidence of massive proteinuria in the ambulatory hypertension group was higher than that in the normal ambulatory blood pressure group [13/21(61.9%) vs. 30/129(23.2%)，P <0.001]. Conclusions The ABP rhythm can alter in 80.00% children with stage Ⅰ-Ⅱ chronic kidney disease combined with proteinuria, mainly in non-dipper and anti-dipping patterns, independent of the type of renal disease and the degree of proteinuria. Ambulatory hypertension is correlated with the degree of proteinuria, which may provide valuable guidance for the rational clinical use of antihypertensive medications.

Key words： Ambulatory blood pressure; Pediatrics; Chronic kidney disease; Proteinuria

Cite this article

SHEN Xiaoyu , SHA Sha , YIN Lei , ZHOU Wei , MAO Youying , WANG Zhangjuan , SUN Yan , WU Yan . Clinical study of ambulatory blood pressure changes in children with stage Ⅰ-Ⅱ chronic kidney disease combined with proteinuria[J]. Journal of Diagnostics Concepts & Practice, 2024 , 23(05) : 531 -536 . DOI: 10.16150/j.1671-2870.2024.05.010

References

[1] STEVENS P E, LEVIN A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and mana-gement of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline[J]. Ann Intern Med, 2013, 158(11):825-830.
[2] SIOMOU E, STEFANIDIS C J. FGF-23 in children with CKD: a new player in the development of CKD-mineral and bone disorde[J]. Nephrol Dial Transplant, 2012, 27(12):4259-4262.
[3] FLYNN J T, 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.
[4] HAMRAHIAN S M, FALKNER B. Hypertension in chronic kidney disease[J]. Adv Exp Med Biol, 2017,956:307-325.
[5] VO N H, PHAM B V, NGUYEN N N, et al. A predictive nomogram for selective screening of chronic kidney disea-se: A population-based study[J]. Can J Kidney Health Dis, 2025,12:20543581241309979.
[6] GUPTA A, NAGARAJU S P, BHOJARAJA M V, et al. Hypertension in chronic kidney disease: An update on diagnosis and management[J]. South Med J, 2023, 116(2):237-244.
[7] FATHALLAH-SHAYKH S A. Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies[J]. Pediatr Nephrol, 2017, 32(5):743-751.
[8] WONG H, MYLREA K, FEBER J, et al. Prevalence of complications in children with chronic kidney disease according to KDOQI[J]. Kidney Int, 2006, 70(3):585-590.
[9] WARADY B A, CHADHA V. Chronic kidney disease in children: the global perspective[J]. Pediatr Nephrol, 2007, 22(12):1999-2009.
[10] FAIVRE A, VERISSIMO T, DE SEIGNEUX S. Proteinuria and tubular cells: Plasticity and toxicity[J]. Acta Physiol (Oxf), 2025, 241(2):e14263.
[11] ROMANO G, FIORINI N, BERTONI M, et al. Effect of combined proteinuria and increased renal resistive index on chronic kidney disease progression: a retrospective longitudinal study[J]. J Clin Med, 2025, 14(1):228.
[12] 全国EGFR课题协作组. MDRD方程在我国慢性肾脏病患者中的改良和评估[J]. 中华肾脏病杂志, 2006, 22(10):589-595.
  Chinese eGFR Investigation Collaboration. Modification and evaluation of MDRD estimating equation for Chinese patients with chronic kidney disease[J]. Chin J Nephrol, 2006, 22(10):589-595.
[13] STERGIOU G S, ALPERT B, MIEKE S, et al. A unive-rsal standard for the validation of blood pressure measu-ring devices: association for the advancement of medical instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement[J]. Hypertension, 2018, 71(3):368-374.
[14] 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.
  Writing Group of the 2020 Chinese Hypertension League Guidelines on Ambulatory Blood Pressure Monitoring. 2020 Chinese Hypertension League Guidelines on ambulatory blood pressure monitoring[J]. Chin Circul J,2021, 36(4):313-328.
[15] FLYNN J T, KAELBER D C, BAKER-SMITH C M, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents[J]. Pediatrics, 2017, 140(3):e20171904.
[16] FLYNN J T, URBINA E M, BRADY T M, et al. Ambulatory blood pressure monitoring in children and adolescents: 2022 Update: a scientific statement from the American Heart Association[J]. Hypertension, 2022, 79(7):e114-e124.
[17] Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the management of glomerular di-seases[J]. Kidney Int, 2021, 100(4S):S1-S276.
[18] LIU Y, HE Q, LI Q, et al. Global incidence and death estimates of chronic kidney disease due to hypertension from 1990 to 2019, an ecological analysis of the global burden of diseases 2019 study[J]. BMC Nephrol, 2023, 24(1):352.
[19] GEORGIANOS P I, AGARWAL R. Hypertension in chronic kidney disease (CKD): diagnosis, classification, and therapeutic targets[J]. Am J Hypertens, 2021, 34(4):318-326.
[20] 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.
[21] 张晓涵, 杨濛, 张霞, 等. 儿童肾脏病并发可逆性后部脑病综合征临床分析[J]. 中国临床研究, 2023, 36(6):889-893.
  ZHANG X H, YANG M, ZHANG X, et al. Reversible posterior encephalopathy syndrome in children with renal disease[J]. Chin J Clin Res, 2023, 36(6):889-893.
[22] Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 Clinical Practice Guideline for the management of blood pressure in chronic kidney disease[J]. idney Int, 2021, 99(3S):S1-S87.
[23] 骆臣, 丁晨慧, 黄新忠. 动态血压与肾性高血压患者肾功能不全的相关性分析[J]. 湖南师范大学学报(医学版), 2021, 18(6):199-202.
  LUO C, DING C H, HUANG X Z. Analysis of correlation between ambulatory blood pressure and renal insufficiency in patients with renal hypertension[J]. J Hunan Normal Univ(Med Sci), 2021, 18(6):199-202.
[24] OLIVERAS A, ARMARIO P, MARTELL-CLARóS N, et al. Urinary albumin excretion is associated with nocturnal systolic blood pressure in resistant hypertensives[J]. Hypertension, 2011, 57(3):556-560.
[25] AFSAR B, ELSURER R. Urinary albumin excretion among nondipper hypertensive patients is closely related with the pattern of nondipping[J]. J Am Soc Hypertens, 2010, 4(4):196-202.
[26] BAKHOUM C Y, VUONG K T, CARTER C E, et al. Proteinuria and nocturnal blood pressure dipping in hypertensive children and adolescents[J]. Pediatr Res, 2021, 90(4):876-881.
[27] 张玉凤. 采用24小时动态血压监测对116例儿童高血压的临床研究[D]. 苏州: 苏州大学儿科临床医学院, 2021:18-22.
  ZHANG Y F. Clinical study on 116 children with hypertension by 24-hour ambulatory blood pressure monitoring[D]. Suzhou: School of Paediatrics, Suzhou University, 2021: 18-22.
[28] 张亚男, 姚丽娜, 牛文明, 等. 动态血压与动态心电图联合在肾实质性高血压监测中的作用[J]. 河北医药, 2021, 43(1):86-89.
  ZHANG Y N, YAO L N, NIU W M, et al. Correlation between dynamic blood pressure combined with dynamic electrocardiogram and renal substantive hypertension[J]. Hebei Med J, 2021, 43(1):86-89.
[29] 沈小钰, 沙莎, 殷蕾, 等. 儿童原发性肾病综合征动态血压变化特点的临床分析[J]. 诊断学理论与实践, 2022, 21(5):613-618.
  SHEN X Y, SHA S, YIN L, et al. Clinical analysis of changes of ambulatory blood pressure in children with primary nephrotic syndrome[J]. J Diagn Concept Pract, 2022, 21(5):613-618.
[30] 曾荣, 郑恪扬, 闫家富, 等. 原发性高血压合并代谢综合征患者的动态血压特点研究[J]. 中国医药, 2021, 16(6):832-836.
  ZENG R, ZHENG K Y, YAN J F, et al. Study on characteristics of ambulatory blood pressure in patients with essential hypertension complicated with metabolic syndrome[J]. China Med, 2021, 16(6):832-836.
[31] ABDALLA M, CAUGHEY M C, TANNER R M, et al. Associations of blood pressure dipping patterns with left ventricular mass and left ventricular hypertrophy in blacks: The jackson heart study[J]. J Am Heart Assoc, 2017, 6(4):e004847.
[32] MINUTOLO R, GABBAI F B, BORRELLI S, et al. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial[J]. Am J Kidney Dis, 2007, 50(6):908-917.
[33] HERMIDA R C, CRESPO J J, DOMíNGUEZ-SARDI?A M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial[J]. Eur Heart J, 2020, 41(48):4565-4576.
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