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Observational Study
. 2025 Sep:284:114443.
doi: 10.1016/j.jpeds.2024.114443. Epub 2024 Dec 20.

Incidence and Risk Factors for Hypertension among Children with Nephrotic Syndrome

Cal Robinson  1 , Stéphanie Wagner  2 , Nowrin Aman  3 , Tonny H M Banh  4 , Vaneet Dhillon  5 , Valerie Langlois  6 , Christoph Licht  7 , Ashlene McKay  7 , Damien Noone  7 , Rachel Pearl  8 , Seetha Radhakrishnan  7 , Chia Wei Teoh  7 , Jovanka Vasilevska-Ristovska  3 , Rulan S Parekh  9
Affiliations
Observational Study

Incidence and Risk Factors for Hypertension among Children with Nephrotic Syndrome

Cal Robinson et al. J Pediatr. 2025 Sep.

Abstract

Objectives: To determine incidence and risk factors for hypertension in childhood nephrotic syndrome.

Study design: Using data from the Insight into Nephrotic Syndrome (INSIGHT) study, a prospective observational childhood nephrotic syndrome cohort from Toronto, Canada, we evaluated hypertension incidence and time-to-hypertension overall and stratified by (1) steroid-resistance or steroid-sensitivity, and (2) frequently-relapsing, steroid dependent, or infrequently-relapsing. Hypertension was defined as stage 1-2 hypertensive blood pressure on 2 consecutive visits or anti-hypertensive medication initiation.

Results: We included 748 children with nephrotic syndrome from 1996 to 2023. Median (quartile 1-3 [Q1-3]) age at diagnosis was 4 (2.8-6) years, 473 (63%) children were male, and 240 (32%) were of South Asian ethnicity. Forty (5%) children were steroid-resistant, 177 (24%) steroid-dependent, 113 (15%) frequently-relapsing, and 418 (56%) infrequently-relapsing. Median follow-up was 5.2 years (Q1-3 3.0-9.3). During follow-up, 393 (53%) children developed hypertension or were initiated on an anti-hypertensive medication (incidence rate 8.2 per 100 person-years, 95% CI 7.4-9.1). Hypertension was more common among children steroid-resistance than steroid-sensitivity (70% vs 52%; adjusted HR 1.47, 95% CI 1.00-2.17). Hypertension was also more common in children who were steroid-dependent (67%; adjusted HR 1.81, 95% CI 1.43-2.30) and frequently-relapsing (63%; adjusted HR 1.64, 95% CI 1.23-2.18), than infrequently-relapsing (42%). Among steroid-sensitive patients, higher body mass index Z-score and academic center were also significant hypertension risk factors.

Conclusions: Half of the children with nephrotic syndrome develop hypertension. Children who are steroid-resistant, steroid-dependent, and frequently-relapsing or have obesity are at greatest risk. Close blood pressure surveillance is justified to identify and treat hypertension.

Keywords: arterial hypertension; blood pressure; children; hypertension; nephrotic syndrome; pediatric.

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Conflict of interest statement

Declaration of Competing Interest This research was supported by grants from the Physicians Services Incorporated (PSI) Foundation and the Hospital for Sick Children Research Institute. R.P. was supported by the Women's College Hospital Research Institute F.M. Hill Chair in Health System Solutions. C.R. received salary support from the Cure Glomerulopathy consortium Career Development Fellowship program, the SickKids Clinician-Scientist Training program, the Canadian Institutes of Health Research Fellowship program, and the Kidney Foundation of Canada KRESCENT program. The other authors have no relevant funding to declare. All authors declare no real or perceived conflicts of interest that could affect the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication.

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