A study to assess the prevalence of hypertension in children with nephrotic syndrome


  • Manasa M. Department Of Pediatrics, Yenapoya Medical College Hospital, Mangalore, Karnataka, India
  • Anitha S. Prabhu Department Of Pediatrics, Yenapoya Medical College Hospital, Mangalore, Karnataka, India
  • Santosh Pai Department of Nephrology, Yenapoya Medical College Hospital, Mangalore, Karnataka, India
  • Kiran Raj H. Department of Pediatrics, Srinivas Institute of Medical Science and Research Centre, Mukka, Mangalore, Karnataka, India




Epithelial sodium channel, Hypertension, Nephrotic Syndrome, Proteinuria, Steroid resistant nephrotic syndrome


Background: Hypertension is been one of the most common co morbidity of this disease. It was mostly attributed to sodium retention, which is a major clinical feature of nephrotic syndrome. These mechanisms likely have a role in the development of hypertension in nephrotic syndrome, where hypertension may be difficult to control, and provide new therapeutic options for the management of blood pressure in the setting of nephrotic syndrome. Objective of study the prevalence of hypertension in children with NS and also the number of antihypertensive required to control it.

Method: A Retrospective study of the hospital records of 100 children diagnosed with nephrotic syndrome admitted to Pediatric and Nephrology Ward at YMCH was accessed.

Results: In our study 35 (35%) of them were Infrequent relapse nephrotic syndrome (IFNS) and 35(35%) were  Frequent relapse nephrotic syndrome (FRNS) ,while 30 cases (30%) were First episode nephrotic syndrome (FENS). 65 cases were steroid sensitive, while 28 and 7 of them were steroid dependent and resistant respectively. Of the 100 study population 54 of them had hypertension while 46 of them did not develop it .Of the 54 hypertensive nephrotic syndrome children, 15 of them (28.%) required three anti hypertensives to control the pressure, while 19 (35%) and 20 (37%) required single and dual anti hypertensives respectively.

Conclusion: Prevalence of hypertension is increasing among the children with nephrotic syndrome. Its more prevalent among the male then female FRNS, SRNS and SDNS are more prone to develop hypertension and also they needed two or more antihypertensives to control the hypertension, whereas hypertension in SSNS could be managed with single drug.


Bryon JL, Priya Pias, Ellis DA. Nephrotic syndrome. In: Kliegman ,Stanton , St Geme, Schor, eds. Nelson textbook of Pediatrics, 20th Edition. Elsevier. 2015:527:2521.

Deschenes G, Wittner M, Stefano A, Jounier S, Doucet A. Collecting duct is a site of sodium retention in PAN nephrosis: a rationale for amiloride therapy. J Am Soc Nephrol. 2001; 12(3):598-601.

Lourdel S, Loffing J, Favre G, Paulais M, Nissant A, Fakitsas P, et al. Hyperaldo steronemia and activation of the epithelial sodium channel are not required for sodium retention in puromycin-induced nephrosis. J Am Soc Nephrol. 2005;16(12):3642-50.

Ray EC, Rondon-Berrios H, Boyd CR, Kleyman TR. Sodium retention and volume expansion in nephrotic syndrome: implications for hypertension. Adv Chronic kidney disease. 2015 May 1;22(3):179-84.

Kim JS, Bellew CA, Silverstein DM, Aviles DH, Boineau FG, Vehaskari VM. High incidence of initial and late steroid resistance in childhood nephrotic syndrome. Kidney international. 2005 Sep 1;68(3):1275-81.

Bagga A. Revised guidelines for management of steroid-sensitive nephrotic syndrome. Indian J Nephrol. 2008 Jan; 18(1):31-9.

Clark AG, Barrat TM. Steroid responsive nephrotic syndrome. In: Barret T.M., Avner E.D, Harman W. E. Pediatric nephrology; 4th edition, 1999:731-747,1031-1037.

Trompeter RS, Lloyd BW, White RHR, Hicks J, Cameron JS. Long-term outcome for children with Mininal change Nephrotic Syndrome. Lancet 1985;i:255-9.

Mishra OP, Teli AS, Singh U, Abhinay A, Prasad R. Serum immunoglobulin E and interleukin-13 levels in children with idiopathic nephrotic syndrome. J tropical pediatr. 2014 Dec 1;60(6):467-71.

Constantinescu AR, Shah HB, Foote EF, Weiss LS. Predicting first-year relapses in children with nephrotic syndrome. Pediatr. 2000 Mar 1;105(3):492-5.

Mishra OP, Prasad R, Singh UK. Disorders of kidney and urinary tract. In: Gupta P, edr. Textbook of Pediatrics. 1st ed. New Delhi: CBS Publishers; 2013:422-454.

Tarshish PE, Tobin JN, Bernstein J, Edelmann CM. Prognostic significance of the early course of Minimal Change Nephrotic Syndrome: report of International study of Kidney disease in Children. JASN May 1997;8(5)768-76.

Ali A, Ali D, Mahran H. Idiopathic Nephrotic Syndrome in Iranian Children. Indian Pediatr. 2008; 45:52-3.

Said AR, Said MS. Hypertension in Jordanian children: a retrospective analysis of 70 cases. Pediatr nephrol. 1990;4(5):520-2.

Ibadin MO, Abiodun PO. Epidemiology and clinicopathologic characteristics of childhood nephrotic syndrome in Benin-City, Nigeria. JPNAJ-PAK-Med-Assoc. 1998;84(8):235-8.

Buhl KB, Oxlund CS, Friis UG, Svenningsen P, Bistrup C, Jacobsen IA, et al. Plasmin in urine from patients with type 2 diabetes and treatment-resistant hypertension activates ENaC in vitro. Journal of hypertension. 2014 Aug 1;32(8):1672-7.

Akhionbare HA. Epidemiology of childhood renal diseases in Africa. Nig J Med. 1998;7(3):97-100.

Asinobi AO, Gbadegesin RA, Adeyemo AA, Akang EE, Arowolo FA, Abiola OA, et al. The predominance of membranoproliferative glomerulonephritis in childhood nephrotic syndrome in Ibadan, Nigeria. West Afr J Med. 1999 Jul;18(3)203-6.

Saca E, Hazza I. Cyclosporine-A Therapy in Steroid Dependent Nephrotic Syndrome. Saudi Arabia J 2002;13(4):520-523.

AL-Mewashi HH. Childhood nephrotic syndrome and frequency of hypertension; M.B.Ch.B.2000.

Gabban NIA, Abdullah EA, Nadhim Abd H. Nephrotic syndrome and Hypertension. Iraqi Journal of Comm. Med. Oct 2010(4):271-6.






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