Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-27T05:20:23.877Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of subclinical cardiovascular risk and cardiac function in children with vesicoureteral reflux: a prospective study

Part of: Echocardiography

Published online by Cambridge University Press:  29 September 2021

Ahmet Midhat Elmacı Open the ORCID record for Ahmet Midhat Elmacı [Opens in a new window] ,
Hayrullah Alp Open the ORCID record for Hayrullah Alp [Opens in a new window]  and
Muhammet İrfan Dönmez Open the ORCID record for Muhammet İrfan Dönmez [Opens in a new window]
Ahmet Midhat Elmacı
Affiliation:
Department of Pediatric Nephrology, Dr. Ali Kemal Belviranlı Women’s Maternity and Children’s Hospital, Konya, Turkey Guest Faculty Member of KTO, Department of Pediatrics, Karatay University, Konya42285, Turkey
Hayrullah Alp*
Affiliation:
Department of Pediatric Cardiology, Dr. Ali Kemal Belviranlı Women’s Maternity and Children’s Hospital, Konya42285, Turkey
Muhammet İrfan Dönmez
Affiliation:
İstanbul University İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, İstanbul34093, Turkey
*
Author for correspondence: H. Alp, MD, Assoc. Prof. Department of Pediatric Cardiology, Dr. Ali Kemal Belviranlı Women’s Maternity and Children’s Hospital, Fatih Mah. Yeni İstanbul Cd. No:32, 42285 Selçuklu, Konya, Turkey. Tel: 0090 506 648 76 53; Fax: 0090 332 237 60 25. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Vesicoureteral reflux is a prominent congenital anomaly of the kidney and the urinary tract. Further, renal scarring is known to be related to chronic inflammation. However, there have been limited studies to date regarding the cardiovascular consequences of vesicoureteral reflux.

Objective:

The aim of this study is to evaluate the possible subclinical atherosclerosis and cardiovascular complications in children with vesicoureteral reflux.

Methods:

Patients with vesicoureteral reflux and age matched healthy controls were prospectively included in this case-control study. Patients were divided into two groups concerning renal scarring status. To assess cardiac functions, carotid artery intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses were evaluated.

Results:

There were 50 patients with vesicoureteral reflux; 26 patients without renal scarring and 24 patients with renal scarring, as well as 40 healthy controls. Myocardial performance indexes (Tei indexes) measured by tissue Doppler echocardiography from septum and left ventricle were significantly increased in study group (for all, p < 0.001). Also, intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses of the study groups were significantly higher than the control group (for all, p < 0.001). However, no statistical difference was observed between renal scarring (−) and renal scarring (+) groups.

Conclusions:

Results of our study showed early deterioration of cardiac systolic and diastolic functions in children with vesicoureteral reflux regardless of renal scarring. Also, diagnosis of vesicoureteral reflux is an important risk factor for subclinical atherosclerosis, independent of renal scarring, which should be considered in the follow-up of these patients.

Keywords

Vesicoureteral refluxcardiac functionsDoppler echocardiographysubclinical atherosclerosischildrenrenal scar
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 8 , August 2022 , pp. 1222 - 1228
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mattoo, TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis 2011; 18: 348–354. DOI 10.1053/j.ackd.2011.07.006.CrossRefGoogle ScholarPubMed
Mattoo, TK, Mathews, R. Vesicoureteral reflux and renal scarring. In: Avner, ED, Harman, WE, Niaudet, P, Yoshikawa, N (eds). Pediatric Nephrology. Springer, Berlin, 2009: 1311–1328.CrossRefGoogle Scholar
Fillion, ML, Watt, CL, Gupta, IR. Vesicoureteric reflux and reflux nephropathy: from mouse models to childhood disease. Pediatr Nephrol 2014; 29: 757–766. DOI 10.1007/s00467-014-2761-3.CrossRefGoogle ScholarPubMed
Gokce, I, Alpay, H, Biyikli, N, Unluguzel, G, Dede, F, Topuzoglu, A. Urinary levels of interleukin-6 and interleukin-8 in patients with vesicoureteral reflux and renal parenchymal scar. Pediatr Nephrol 2010; 25: 905–912. DOI 10.1007/s00467-009-1396-2.CrossRefGoogle ScholarPubMed
Galanakis, E, Bitsori, M, Dimitriou, H, Giannakopoulou, C, Karkavitsas, NS, Kalmanti, M. Urine interleukin-8 as a marker of vesicoureteral reflux in infants. Pediatrics 2006; 117: e863–867. DOI 10.1542/peds.2005-2051.CrossRefGoogle ScholarPubMed
Sabasiñska, A, Zoch-Zwierz, W, Wasilewska, A, Porowski, T. Laminin and transforming growth factor beta-1 in children with vesicoureteric reflux. Pediatr Nephrol 2008; 23: 769–774. DOI 10.1007/s00467-007-0723-8.CrossRefGoogle ScholarPubMed
Moreira, DM, da Silva, RL, Vieira, JL, Fattah, T, Lueneberg, ME, Gottschall, CA. Role of vascular inflammation in coronary artery disease: potential of anti-inflammatory drugs in the prevention of atherothrombosis. Inflammation and anti-inflammatory drugs in coronary artery disease. Am J Cardiovasc Drugs 2015; 15: 1–11. DOI 10.1007/s40256-014-0094-z.CrossRefGoogle ScholarPubMed
Okazaki, S, Sakaguchi, M, Miwa, K, Furukado, S, Yamagami, H, Yagita, Y. Association of interleukin-6 with the progression of carotid atherosclerosis: a 9-year follow-up study. Stroke 2014; 45: 2924–2929. DOI 10.1161/STROKEAHA.114.005991.CrossRefGoogle ScholarPubMed
Djaberi, R, Schuijf, JD, van Werkhoven, JM, Nucifora, G, Jukema, JW, Bax, JJ. Relation of epicardial adipose tissue to coronary atherosclerosis. Am J Cardiol 2008; 102: 1602–1607. DOI 10.1016/j.amjcard.2008.08.010.CrossRefGoogle ScholarPubMed
Bakkaloglu, SA, Saygili, A, Sever, L, et al. Assessment of cardiovascular risk in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report. Nephrol Dial Transplant 2009; 24: 3525–3532. DOI 10.1093/ndt/gfp297.CrossRefGoogle Scholar
Akyürek, N, Atabek, ME, Eklioglu, BS, Alp, H. Evaluation of the relationship between cardiovascular risk factors and periaortic fat thickness in children with type 1 diabetes mellitus. Diabetes Metab 2015; 41: 338–341. DOI 10.1016/j.diabet.2015.02.005.CrossRefGoogle ScholarPubMed
de Ferranti, SD, Steinberger, J, Ameduri, R, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association. Circulation 2019; 139: e603–e634. DOI 10.1161/CIR.0000000000000618.CrossRefGoogle ScholarPubMed
Lebowitz, RL, Olbing, H, Parkkulainen, KV, Smellie, JM, Tamminen-Möbius, TE. International system of radiographic grading of vesicoureteric reflux. International reflux study in children. Pediatr Radiol 1985; 15: 105–109.CrossRefGoogle ScholarPubMed
Imperiale, A, Olianti, C, Sestini, S, et al. 123I-hippuran renal scintigraphy with evaluation of single-kidney clearance for predicting renal scarring after acute urinary tract infection: comparison with (99m)Tc-DMSA scanning. J Nucl Med 2003; 44: 1755–1760.Google ScholarPubMed
Cain, JE, Di Giovanni, V, Smeeton, J, Rosenblum, ND. Genetics of renal hypoplasia: insights into the mechanisms controlling nephron endowment. Pediatr Res 2010; 68: 91–98. DOI 10.1203/PDR.0b013e3181e35a88.CrossRefGoogle ScholarPubMed
Schwartz, GJ, Muñoz, A, Schneider, MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20: 629–637. DOI 10.1681/ASN.2008030287.CrossRefGoogle ScholarPubMed
Lang, RM, Bierig, M, Devereux, RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463. DOI 10.1016/j.echo.2005.10.005.CrossRefGoogle ScholarPubMed
Devereux, RB, Reichek, N. Echocardiographic determination of left ventricularmass in man. Anatomic validation of the method. Circulation 1977; 55: 613–618.CrossRefGoogle Scholar
Tei, C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995; 26: 135–136.Google ScholarPubMed
Iacobellis, G, Bianco, AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab 2011; 22: 450–457. DOI 10.1016/j.tem.2011.07.003.CrossRefGoogle ScholarPubMed
Touboul, PJ, Hennerici, MG, Meairs, S, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012; 34: 290–296. DOI 10.1159/000343145.CrossRefGoogle Scholar
Akyürek, N, Atabek, ME, Eklioglu, BS, Alp, H. The relationship of periaortic fat thickness and cardiovascular risk factors in children with Turner syndrome. Pediatr Cardiol 2015; 36: 925–929. DOI 10.1007/s00246-015-1098-4.CrossRefGoogle ScholarPubMed
Border, WA, Noble, NA. Transforming growth factor beta in tissue fibrosis. N Engl J Med 1994; 331: 1286–1292.Google ScholarPubMed
Morozova, O, Morozov, D, Pervouchine, D, et al. Urinary biomarkers of latent inflammation and fibrosis in children with vesicoureteral reflux. Int Urol Nephrol 2020; 52: 603–610. DOI 10.1007/s11255-019-02357-1.CrossRefGoogle ScholarPubMed
Marchio, P, Guerra-Ojeda, S, Vila, JM, Aldasoro, M, Victor, VM, Mauricio, MD. Targeting early atherosclerosis: a focus on oxidative stress and inflammation. Oxid Med Cell Longev 2019; 2019: 8563845. DOI 10.1155/2019/8563845.CrossRefGoogle ScholarPubMed
Järvisalo, MJ, Jartti, L, Näntö-Salonen, K, et al. Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation 2001; 104: 2943–2947. DOI 10.1161/hc4901.100522.CrossRefGoogle ScholarPubMed
Bots, ML. Carotid intima-media thickness as a surrogate marker for cardiovascular disease in intervention studies. Curr Med Res Opin 2006; 22: 2181–2190. DOI 10.1185/030079906X148472.CrossRefGoogle ScholarPubMed
Aeddula, NR, Cheungpasitporn, W, Thongprayoon, C, Pathireddy, S. Epicardial adipose tissue and renal disease. J Clin Med 2019; 8: 299. DOI 10.3390/jcm8030299.CrossRefGoogle ScholarPubMed
Nakanishi, K, Fukuda, S, Tanaka, A, et al. Epicardial adipose tissue accumulation is associated with renal dysfunction and coronary plaque morphology on multidetector computed tomography. Circ J 2016; 80: 196–201. DOI 10.1253/circj.CJ-15-0477.CrossRefGoogle ScholarPubMed
Venuraju, SM, Lahiri, A, Jeevarethinam, A, Rakhit, RD, Shah, PK, Nilsson, J. Association of epicardial fat volume with the extent of coronary atherosclerosis and cardiovascular adverse events in asymptomatic patients with diabetes. Angiology 2021; 72: 442–450. DOI 10.1177/0003319720984607.CrossRefGoogle ScholarPubMed
Manco, M, Morandi, A, Marigliano, M, Rigotti, F, Manfredi, R, Maffeis, C. Epicardial fat, abdominal adiposity and insulin resistance in obese pre-pubertal and early pubertal children. Atherosclerosis 2013; 226: 490–495. DOI 10.1016/j.atherosclerosis.2012.11.023.CrossRefGoogle ScholarPubMed
Harada, K, Tamura, M, Yasuoka, K, Toyono, M. A comparison of tissue Doppler imaging and velocities of transmitral flow in children with elevated left ventricular preload. Cardiol Young 2001; 11: 261–268. DOI 10.1017/s1047951101000270.CrossRefGoogle ScholarPubMed
Lopez, L, Colan, SD, Frommelt, PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23: 465–495. DOI 10.1016/j.echo.2010.03.019.CrossRefGoogle ScholarPubMed
Doyon, A, Haas, P, Erdem, S, et al. Impaired systolic and diastolic left ventricular function in children with chronic kidney disease - results from the 4C study. Sci Rep 2019; 9: 11462. DOI 10.1038/s41598-019-46653-3.CrossRefGoogle ScholarPubMed
Celik, SF, Karakurt, C, Tabel, Y, Elmas, T, Yologlu, S. Blood pressure is normal, but is the heart? Pediatr Nephrol 2018; 33: 1585–1591. DOI 10.1007/s00467-018-3968-5.CrossRefGoogle ScholarPubMed