Cardiac functions in children with steroid-sensitive nephrotic syndrome

Pediatr Int. 2020 Dec;62(12):1364-1368. doi: 10.1111/ped.14285. Epub 2020 Dec 5.


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 and urine samples, two M-mode conventional echocardiograms and tissue Doppler velocity imaging 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 the control group, indicating diastolic dysfunction (overall P = 0.003 and P = 0.006, respectively). Based on tissue Doppler velocity imaging 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 periods compared to in debut/relapse periods (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. The persistence of left ventricular (LV) dysfunction during the remission period requires special attention during the follow up for early detection of cardiac abnormalities.

Keywords: echocardiography; nephrotic syndrome; pediatrics; tissue Doppler echocardiography; ventricular function.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Diastole
  • Echocardiography / methods
  • Echocardiography, Doppler / methods
  • Female
  • Heart / physiopathology
  • Humans
  • Infant
  • Male
  • Nephrotic Syndrome / drug therapy
  • Nephrotic Syndrome / physiopathology*
  • Prospective Studies
  • Pulse Wave Analysis / methods
  • Serum Albumin / analysis
  • Steroids / therapeutic use
  • Systole
  • Ventricular Dysfunction, Left / diagnosis*
  • Ventricular Function


  • Serum Albumin
  • Steroids