Background: Adiponectin (ADPN), a protein hormone (cytokine), is exclusively expressed on and
secreted from adipocytes. It is a particularly interesting compound because it may
have a protective influence on the cardiovascular system. Objective: This study was designed to evaluate serum ADPN level, right ventricular functions
and metabolic profiles among children with nephrotic syndrome (NS) and asses the correlations
between ADPN as a protective hormone and each of right ventricular functions and metabolic
profiles. Patients and Methods: A total of 47 children (28 boys; 19 girls) with steroid-responsive nephrotic syndrome
(SRNS) were studied. They included two groups: Group A: included 25 children with
SRNS in relapse. Group B: included 22 children with SRNS in remission for periods
ranging from 3-9 months. A control group included 28 children with matched age and
sex. Methods: Serum level of ADPN was estimated by ELISA and nitric oxide (NO) by
chemical detection. In addition to total cholesterol, triglycerides, high-density
lipoprotein (HDL), low density lipoprotein (LDL), total protein, and albumin by Enzymatic
Colorimetric kits. Also, 24-hour urine samples were collected for detection of proteinuria.
Electrocardiogram (ECG) and echocardiography measuring right ventricular wall functions
were done. Results: Serum levels of ADPN and NO were significantly higher in children with SRNS in relapse
in comparison with children with SRNS in remission or control group. Children with
SRNS in relapse showed significantly higher levels of total cholesterol, triglycerides,
LDL and proteinuria while significantly lower levels of total protein, albumin and
HDL as compared with SRNS in remission or control group. Echocardiographic findings
revealed that a significant decrease in right ventricular ejection fraction (RVEF
%) and significant increase in right ventricular end diastolic diameter (RVEDD), right
ventricular peak pressure (RVPP) and pulmonary artery pressure (PAP) were found in
cases with SRNS in relapse in comparison to cases with SRNS in remission and control
hypertrophy in relapsed cases. Finally, in children with SRNS in relapse it was found
that serum ADPN level was significantly positively correlated with each of serum NO,
total cholesterol, triglycerides, LDL, proteinuria, RVEDD, RVPP and PAP, while significantly
negatively correlated with serum total protein, albumin and RVEF%.
Conclusion: During relapse of SRNS, serum ADPN level is higher than its level in SRNS in remission.
This higher level may represent a physiologic response to the altered metabolic profiles
and right ventricular strain so as to minimize cardiovascular complications.
Key-words:
Adiponectin - Nephrotic syndrome - Right ventricular function - Nitric oxide proteinuria.
