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Alazem EAA, El-Saiedi SA, Chitrakar S, Othman SA. Ambulatory blood pressure monitoring in Egyptian children with nephrotic syndrome: single center experience. Ital J Pediatr 2024; 50:214. [PMID: 39396026 PMCID: PMC11470724 DOI: 10.1186/s13052-024-01775-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 09/22/2024] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND Hypertension (HTN), especially masked hypertension, is one of the cardiovascular consequences of nephrotic syndrome. Masked hypertension cannot be identified during routine follow-up visits and adversely effects the patients' cardiac function. The purpose of this study was to use ambulatory blood pressure monitoring (ABPM) to evaluate the blood pressure status of children with nephrotic syndrome. METHODS Ninety children with nephrotic syndrome (NS) participated in this cross-sectional study, which was carried out at Cairo University Children Hospital's nephrology clinic (CUCH). A sphygmomanometer was used in the clinic to measure blood pressure, and a Meditech monitor was used for 24-hour ambulatory blood pressure monitoring (ABPM). Interventricular septum (IVS) was measured, and heart functions were evaluated, using echocardiography. RESULTS Two groups comprised the included patients: Group1 (n = 70): HTN group included masked and ambulatory hypertension, and Group 2 (n = 20): non-HTN group included normal blood pressure, white coat HTN and well controlled HTN, 35% of the studied cohort (n = 32/90) had masked HTN.The serum urea was significantly higher in HTN group than non-HTN group with p-value: 0.047, while the serum albumin was significantly lower in HTN group than non-HTN group with p-value: 0.017. The cut-off point of 9.9, the sensitivity and specificity of serum urea to predict the occurrence of hypertension in NS patients was 92.9% and 35% respectively, with p-value : 0.024 and 95% CI (0.534-0.798). The z score of IVS is significantly higher in group 1 (2.5 ± 1.2) when compared to group 2 (1.7 ± 2.1) with p-value: 0.025 and Among group 1, it was noticed that 74% (n = 52/70) of them were systolic non-dipper, also it was observed that the mean serum potassium and cholesterol were significantly higher among systolic non-dipper when compared with systolic dipper patients with p-values: 0.045 and 0.005 respectively. CONCLUSION Children with nephrotic syndrome are particularly vulnerable to experience ambulatory hypertension and masked hypertension, which may adversely impact their cardiac condition because they are not detectable by standard blood pressure readings at the clinic.
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Affiliation(s)
- Eman Abobakr Abd Alazem
- Division of pediatric nephrology, Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Sonia Ali El-Saiedi
- Division of pediatric cardiology, Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shradha Chitrakar
- Division of pediatric nephrology, Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shorouk A Othman
- Division of pediatric nephrology, Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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2
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Kamel AS, AlGhawass MME, Sayed MA, Roby SA. Evaluation of carotid intima media thickness in children with idiopathic nephrotic syndrome. Ital J Pediatr 2022; 48:195. [PMID: 36494853 PMCID: PMC9733087 DOI: 10.1186/s13052-022-01383-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Nephrotic syndrome is the one of the commonest renal disorders in children. Children with nephrotic syndrome (NS) are at a high risk of atherosclerosis due to hyperlipidemia, hypertension. Carotid intima media thickness (CIMT) is a surrogate marker for atherosclerosis. This study aimed to evaluate the carotid intima media thickness in children with nephrotic syndrome and its relation to different risk factors. METHODS This is an observational case control study that included forty children with nephrotic syndrome and thirty healthy children as controls. The inclusion criteria were: age of 2 years or more with disease duration of minimum of 1 year and glomerular filtration rate > 90 mL/min/1.73m2. CIMT was assessed by ultrasound. Lipid profile, protein/creatinine ratio in urine and kidney function tests were done. RESULTS The mean CIMT (mm) was significantly higher in patients with NS (0.477 ± 0.04) compared to controls (0.39 ± 0.03) (P < 0.001) even when compared across different age groups. 60% of patients had received non-steroid immunosuppressive therapy. CIMT was significantly higher in patients receiving non-steroid immunosuppressive therapy than those receiving steroids alone. Subsequently, CIMT had significant positive correlation to duration of the disease (p = 0.05), body mass index (BMI) (p = 0.03), number of relapses (p = 0.01) and diastolic blood pressures (p = 0.003). CONCLUSION Children with NS had significantly higher CIMT than control group. CIMT was positively correlated to disease duration, number of relapses and BMI. It was significantly higher among patients receiving non-steroid immunosuppressive therapy than those receiving steroids alone.
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Affiliation(s)
- Ashraf Sayed Kamel
- grid.411170.20000 0004 0412 4537Pediatrics department, Faculty of Medicine, Fayoum University, Fayoum city, Egypt
| | | | - Muhammad Adel Sayed
- grid.411170.20000 0004 0412 4537Pediatrics department, Faculty of Medicine, Fayoum University, Fayoum city, Egypt
| | - Sara Aly Roby
- grid.411170.20000 0004 0412 4537Radiology department, Faculty of Medicine, Fayoum University, Fayoum city, Egypt
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3
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Zhang X, Li G, Shi C, Zhang D, Sun Y. Combined superposition effect of hypertension and dyslipidemia on left ventricular hypertrophy. Animal Model Exp Med 2022; 5:227-238. [PMID: 35746831 PMCID: PMC9240736 DOI: 10.1002/ame2.12249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hypertension and dyslipidemia are considered reversible risk factors for cardiovascular disease. The purpose of this study was to explore the impact of traditional and nontraditional blood lipid profiles on the risk of left ventricular hypertrophy (LVH) and to explore the superposition effect of dyslipidemia combined with hypertension. METHODS Data on 9134 participants (53.5 ± 10.3 years old) from the Northeast China Rural Cardiovascular Health Study (NCRCHS) were statistically analyzed. The blood lipid profile was measured by total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total glyceride (TG), and calculated nontraditional blood lipid indices including non-HDL-C, atherosclerosis index (AI), TC/HDL-C, and residual cholesterol (RC). RESULTS After the adjustment of age and gender, the odds ratios (ORs) of LVH in patients with hypertension, high LDL-C, high non-HDL-C, high AI, and high TC/HDL-C were 3.97 (3.31-4.76), 1.27 (1.02-1.59), 1.21 (1.04-1.39), 1.33 (1.15-1.53), and 1.42 (1.22-1.65), respectively. After full adjustment of potential confounding factors, high AI and TC/HDL-C were associated with LVH rather than traditional blood lipid indices. The combination of hypertension and nontraditional dyslipidemia (defined by high AI and TC/HDL-C) was associated with the highest risk of LVH, especially in participants under 45 years of age. The risk was more significant in men, 5.09-fold and 6.24-fold, respectively, compared with 3.66-fold and 4.01-fold in women. CONCLUSIONS People with dyslipidemia defined by nontraditional blood lipid indices (high AI and high TC/HDL-C) and hypertension were more likely to develop LVH.
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Affiliation(s)
- Xueyao Zhang
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| | - Guangxiao Li
- Department of Medical Record ManagementFirst Hospital of China Medical UniversityShenyangChina
| | - Chuning Shi
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| | - Dongyuan Zhang
- NHC Key Laboratory of Human Disease Comparative MedicineInstitute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS), Comparative Medicine Center, Peking Union Medical College (PUMC)BeijingChina
| | - Yingxian Sun
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
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Ahmed HM, Ameen EED, Awad MS, Botrous OE. Assessment of Carotid Intima Media Thickness and Left Ventricular Mass Index in Children with Idiopathic Nephrotic Syndrome. Vasc Health Risk Manag 2021; 17:349-356. [PMID: 34140775 PMCID: PMC8203195 DOI: 10.2147/vhrm.s295868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children with nephrotic syndrome (NS) are at a greater risk of atherosclerosis due to recurrent exposures to hyperlipidemia, hypertension, and immunosuppressive medications. CIMT (carotid intima media thickness) is a reliable marker for assessment of atherosclerosis of large and medium-sized blood vessels; endothelial dysfunction and increased CIMT usually precede the development of cardiovascular diseases. Some manifestations of NS, like proteinuria and hyperlipidemia, are associated with an increased risk of cardiac morbidity and mortality. The aim of the current study was to evaluate the carotid intima media thickness and LVM (left ventricular mass) thickness in children with nephrotic syndrome. SUBJECTS AND METHODS Eighty-one children with nephrotic syndrome and 100 healthy children as controls were enrolled in the study. The inclusion criteria were: disease duration of minimum of 12 months, glomerular filtration rate >60mL/min/1.73m 2 and children aged two years or more at the time of study. CIMT and left ventricular mass index, lipid profile, protein/creatinine ratio in urine and kidney function tests were done for cases and controls after approval of internal ethical committee. RESULTS The mean CIMT (mm) was significantly higher in NS (0.51± 0.12) compared to controls (0.42± 0.09) (P <0.001). LVM and LVM Index were significantly higher in NS than controls (p< 0.001, for both). Subsequently, CIMT was significantly correlated to duration of the disease (p< 0.001), LVM index was significantly correlated with duration of the disease, body mass index (BMI), blood pressures and triglycerides level (p< 0.05). CONCLUSION Children with NS are at increasing risk to develop atherosclerosis as measured by CIMT. LVM was significantly higher in NS and positively correlated to BP, disease duration, triglyceride levels and BMI.
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Affiliation(s)
- Heba Mostafa Ahmed
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Emad El-Deen Ameen
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mohammad Shafiq Awad
- Department of Cardiology, Faculty of Medicine, Beni- Suef University, Beni Suef, Egypt
| | - Osama Ezzat Botrous
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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Paripović A, Stajić N, Putnik J, Gazikalović A, Bogdanović R, Vladislav V. Evaluation of carotid intima media thickness in children with idiopathic nephrotic syndrome. Nephrol Ther 2020; 16:420-423. [PMID: 33162364 DOI: 10.1016/j.nephro.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/26/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
AIM Aim of the study was to determine if carotid intima media thickness in children with idiopathic nephrotic syndrome is greater than in healthy subjects, and to assess whether carotid intima media thickness in children with nephrotic syndrome is associated with clinical (including disease duration, cumulative dose of steroids, number of relapses) and biochemical parameters. METHODS A cross-sectional study included 40 patients with nephrotic syndrome (mean age 11.7±4.7 years). Steroid dependent nephrotic syndrome was established in 32 patients (80%), while 8 (20%) had steroid resistant nephrotic syndrome. Control group consisted of 20 age and gender matched healthy children. Blood pressure based on 24-h ambulatory blood pressure monitoring (ABPM), carotid intima media thickness, fasting glucose, insulin, HbA1c, lipid concentrations were measured in all children. RESULTS A significant difference was detected in carotid intima media thickness values (P=0.036). Children with nephrotic syndrome had significantly greater carotid intima media thickness compared with healthy children (0.42±0.06 and 0.38±0.03mm). Carotid intima-media thickness was positively associated with duration of nephrotic syndrome (r=0.45; P=0.004), body mass index (r=0.48; P=0.002), daytime systolic blood pressure (r=0.46; P=0.003) and night-time systolic blood pressure (r=0.52; P=0.001). Multiple linear regression showed that duration of nephrotic syndrome was the only independent predictor of carotid intima media thickness in children with nephrotic syndrome (R2=0.244; β=0.327; P=0.037). CONCLUSION The findings of the present study suggest subclinical vascular damage in patients with nephrotic syndrome. Duration of nephrotic syndrome was the only independent predictor of carotid intima media thickness.
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Affiliation(s)
- Aleksandra Paripović
- Nephrology department, Institute for Mother and Child Health, Radoja Dakića 4, 11070 New Belgrade, Serbia.
| | - Nataša Stajić
- Nephrology department, Institute for Mother and Child Health, Radoja Dakića 4, 11070 New Belgrade, Serbia; School of medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Putnik
- Nephrology department, Institute for Mother and Child Health, Radoja Dakića 4, 11070 New Belgrade, Serbia
| | - Ana Gazikalović
- Radiology department, Institute for Mother and Child Health, Radoja Dakića 4, 11070 New Belgrade, Serbia
| | - Radovan Bogdanović
- Nephrology department, Institute for Mother and Child Health, Radoja Dakića 4, 11070 New Belgrade, Serbia; School of medicine, University of Belgrade, Belgrade, Serbia
| | - Vukomanović Vladislav
- School of medicine, University of Belgrade, Belgrade, Serbia; Cardiology department, Institute for Mother and Child Health, Radoja Dakića 4, 11070 New Belgrade, Serbia
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6
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Fortes PM, Teles Filho RV, Azevêdo LHSD, Queiroz VCJ, Costa PSSD. Inflammatory cytokines and lipid profile in children and adolescents with nephrotic syndrome receiving L. Plantarum: a randomized, controlled feasibility trial. Rev Assoc Med Bras (1992) 2020; 66:1487-1492. [PMID: 33295397 DOI: 10.1590/1806-9282.66.11.1487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022] Open
Abstract
METHODS This study aimed to evaluate the efficacy of the action of the Lactobacillus Plantarum probiotic as a immunomodulatory and hypolipidemic agent in dyslipidemic nephrotic children and adolescents. This is a randomized, double-blind, placebo-controlled clinical trial in pediatric, compensated or partially compensated nephrotic syndrome and dyslipidemic subjects undergoing regular outpatient follow-up. Serum lipid and TNF-α (proinflammatory) and IL-10 (anti-inflammatory) cytokine variations were evaluated. Cytokines were analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS In the probiotic group there was a tendency to reduce TNF-α levels and increase IL-10 levels when compared to controls. Regarding the lipid profile, there was a decrease in serum triglyceride (6.0 mg / dL) and total cholesterol (41.5 mg / dL) levels in the probiotic group when compared to baseline levels, while in the control group there was an increase in serum triglyceride (49.5 mg / dL) and total cholesterol (8.0 mg / dL) levels, respectively. CONCLUSION Preliminary results suggest that L. Plantarum showed an immunomodulatory and hypolipidemic effect in nephrotic and dyslipidemic pediatric subjects.
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Affiliation(s)
- Patrícia Marques Fortes
- Departamento de Pediatria, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, Goiás, GO, Brasil
| | | | | | | | - Paulo Sérgio Sucasas da Costa
- Departamento de Pediatria, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, Goiás, GO, Brasil
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Hari P, Khandelwal P, Smoyer WE. Dyslipidemia and cardiovascular health in childhood nephrotic syndrome. Pediatr Nephrol 2020; 35:1601-1619. [PMID: 31302760 DOI: 10.1007/s00467-019-04301-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/11/2019] [Accepted: 07/01/2019] [Indexed: 12/11/2022]
Abstract
Children with steroid-resistant nephrotic syndrome (SRNS) are exposed to multiple cardiovascular risk factors predisposing them to accelerated atherosclerosis. This risk is negligible in steroid-sensitive nephrotic syndrome, but a substantial proportion of children with SRNS progress to chronic kidney disease, exacerbating the already existing cardiovascular risk. While dyslipidemia is an established modifiable risk factor for cardiovascular disease in adults with NS, it is uncertain to what extent analogous risks exist for children. There is increasing evidence of accelerated atherosclerosis in children with persistently high lipid levels, especially in refractory NS. Abnormalities of lipid metabolism in NS include hypertriglyceridemia and hypercholesterolemia due to elevated apolipoprotein B-containing lipoproteins, decreased lipoprotein lipase and hepatic lipase activity, increased hepatic PCSK9 levels, and reduced hepatic uptake of high-density lipoprotein. Existing guidelines for the management of dyslipidemia in children may be adapted to target lower lipid levels in children with NS, but they will most likely require both lifestyle modifications and pharmacological therapy. While there is a lack of data from randomized controlled trials in children with NS demonstrating the benefit of lipid-lowering drugs, therapies including statins, bile acid sequestrants, fibrates, ezetimibe, and LDL apheresis have all been suggested and/or utilized. However, concerns with the use of lipid-lowering drugs in children include unclear side effect profiles and unknown long-term impacts on neurological development and puberty. The recent introduction of anti-PCSK9 monoclonal antibodies and other therapies targeted to the molecular mechanisms of lipid transport disrupted in NS holds promise for the future treatment of dyslipidemia in NS.
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Affiliation(s)
- Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - William E Smoyer
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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8
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Augmentation index, a predictor of cardiovascular events, is increased in children and adolescents with primary nephrotic syndrome. Pediatr Nephrol 2020; 35:815-827. [PMID: 31845056 DOI: 10.1007/s00467-019-04434-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Arterial stiffness is associated with an increased risk of cardiovascular diseases. Augmentation index (AIx@75), a measure of arterial stiffness and wave reflection, has not been evaluated in patients with primary nephrotic syndrome (PNS). We investigated whether central and peripheral vascular profiles, hemodynamic parameters, and biochemical tests are associated with AIx@75 in PNS patients. METHODS This observational study involved 38 children and adolescents with PNS (12.14 ± 3.65 years) and 37 healthy controls (13.28 ± 2.80 years). Arterial stiffness and vascular and hemodynamic parameters were measured noninvasively using the Mobil-O-Graph® (IEM, Stolberg, Germany). In the PNS group, biochemical tests and corticosteroid dosage/treatment time were analyzed. RESULTS Peripheral and central systolic blood pressure (SBPp, SBPc) Z-scores were significantly higher in the PNS patients. AIx@75 was significantly higher in the PNS patients (25.14 ± 9.93%) than in controls (20.84 ± 7.18%). In the control group, AIx@75 negatively correlated with weight (r = - 0.369; p = 0.025), height (r = - 0.370; p = 0.024), and systolic volume/body surface (r = - 0.448; p = 0.006). In the PNS group, a univariate linear correlation showed that AIx@75 negatively correlated with weight (r = - 0.360; p = 0.027), height (r = 0.381; p = 0.18), and systolic volume/body surface (r = - 0.447; p < 0.002) and positively with the Z-score of SBPp (r = 0.407; p = 0.011), peripheral diastolic blood pressure (DBPp, r = 0.452; p = 0.004), SBPc (r = 0.416; p = 0.009), DBPc (r = 0.407; p = 0.011), triglycerides (r = 0.525; p = 0.001), and cholesterol [total (r = 0.539; p < 0.001), LDLc (r = 0.420; p = 0.010), and non-HDLc (r = 0.511; p = 0.001)]. CONCLUSIONS Early abnormalities of AIx@75 and vascular parameters suggest that patients with PNS, even in stable condition, present subclinical indicators for the development of cardiovascular disease.
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9
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Yang M, Pan X, Liang Z, Huang X, Duan M, Cai H, Yu L, Chen L. Clinical Features of Nephrotic Syndrome with Cerebral Hemorrhage. Med Sci Monit 2019; 25:2179-2185. [PMID: 30904921 PMCID: PMC6442498 DOI: 10.12659/msm.912466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Cerebral hemorrhage has been increasingly reported in patients with nephrotic syndrome (NS). However, the clinical features and pathogenesis of NS patients with cerebral hemorrhage remain unclear. Material/Methods From January 2007 to August 2017, continuous NS patients with cerebral hemorrhage at the First Affiliated Hospital of Guangxi Medical University were selected. The clinical manifestations, laboratory measurements, and neurological images of these patients were collected and analyzed. Results Acute cerebral hemorrhage was recorded in 15 of 10 461 NS patients. The average age of these 15 patients (9 males and 6 females) was 50.87±23.27 years old. Among these 15 patients, conventional vascular risk factors were identified in 8 patients, hypoalbuminemia and proteinuria were recorded in all 15 patients, coagulopathy was observed in 9 patients, increased D-dimer level was recorded in 13 patients, hyperlipidemia was recorded in 11 patients, and impaired renal function was recorded in 9 patients. The hemorrhage developed in the lobe (n=9), basal ganglia (n=3), cerebellum (n=2), and cerebral hemisphere (n=1). Eight patients were in a coma on the day the cerebral hemorrhage occurred, while 12 patients had a poor prognosis after 30 days of hemorrhage onset. Conclusions Poor prognosis was recorded in NS patients with cerebral hemorrhage. Although conventional vascular risk factors have only been identified in 8 patients, biochemical abnormalities (hypoalbuminemia, proteinuria, elevated D-dimer, and hyperlipidemia) were recorded in the majority of these 15 patients. Furthermore, most of the hemorrhages developed in the lobes. Coagulopathy might be the potential pathogenesis of cerebral hemorrhage in NS patients.
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Affiliation(s)
- Mengqi Yang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xueying Pan
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Zhijian Liang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xiaoqin Huang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Meiyi Duan
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Hui Cai
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Lixia Yu
- Medical Records Room, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Li Chen
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
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10
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Shatat IF, Becton LJ, Woroniecki RP. Hypertension in Childhood Nephrotic Syndrome. Front Pediatr 2019; 7:287. [PMID: 31380323 PMCID: PMC6646680 DOI: 10.3389/fped.2019.00287] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/26/2019] [Indexed: 11/20/2022] Open
Abstract
Arterial hypertension (HTN) is commonly encountered by clinicians treating children with steroid sensitive (SSNS) and steroid resistant nephrotic syndrome (SRNS). Although the prevalence of HTN in SSNS is less documented than in SRNS, recent studies reported high prevalence in both. Studies have estimated the prevalence of HTN in different patient populations with NS to range from 8 to 59.1%. Ambulatory HTN, abnormalities in BP circadian rhythm, and measures of BP variability are prevalent in patients with NS. Multiple mechanisms and co-morbidities contribute to the pathophysiology of HTN in children with NS. Some contributing factors are known to cause acute and episodic elevations in blood pressure such as fluid shifts, sodium retention, and medication side effects (steroids, CNIs). Others are associated with chronic and more sustained HTN such as renal fibrosis, decreased GFR, and progression of chronic kidney disease. Children with NS are more likely to suffer from other cardiovascular disease risk factors, such as obesity, increased measures of arterial stiffness [increased carotid intima-media thickness (cIMT), endothelial dysfunction, increased pulse wave velocity (PWV)], impaired glucose metabolism, dyslipidemia, left ventricular hypertrophy (LVH), left ventricular dysfunction, and atherosclerosis. Those risk factors have been associated with premature death in adults. In this review on HTN in patients with NS, we will discuss the epidemiology and pathophysiology of hypertension in patients with NS, as well as management aspects of HTN in children with NS.
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Affiliation(s)
- Ibrahim F Shatat
- Pediatric Nephrology and Hypertension, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Weill Cornell College of Medicine-Qatar, Doha, Qatar.,College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Lauren J Becton
- Private Practice Practitioner, Pediatric Nephrology, Seattle, WA, United States
| | - Robert P Woroniecki
- Pediatric Nephrology and Hypertension, Stony Brook Children's Hospital, Stony Brook, NY, United States
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12
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Patnaik SK, Kumar P, Bamal M, Patel S, Yadav MP, Kumar V, Sinha A, Bagga A, Kanitkar M. Cardiovascular outcomes of Nephrotic syndrome in childhood (CVONS) study: a protocol for prospective cohort study. BMC Nephrol 2018; 19:81. [PMID: 29614967 PMCID: PMC5883594 DOI: 10.1186/s12882-018-0878-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/19/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Nephrotic syndrome (NS) is characterized by dyslipidemia which is a well-known risk factor for atherogenesis. Atherosclerosis in childhood is mostly subclinical and endothelial dysfunction is known to precede this. Evidence for screening for endothelial dysfunction and cardiovascular risk factors and early identification of premature onset of atherosclerosis in childhood NS remains tenuous in the absence of well-designed prospective studies addressing cardiovascular comorbidity in NS. The objective of our study is to examine endothelial dysfunction and short-term cardiovascular outcomes in a carefully phenotyped cohort of patients with Nephrotic syndrome as compared to healthy controls. METHODS In a multi-centric prospective cohort study, 70 Steroid Resistant NS (SRNS), 70 Steroid Sensitive (SSNS) patients along with 70 Healthy Controls are being recruited. After a baseline assessment of functional and structural status of heart (2D Echocardiography), arteries (Carotid Doppler and Intima Media Thickness measurements) and microcirculation [a combination of 2D Echocardiography, Laser Doppler Flowmetry (LDF) and Brachial Artery Flow mediated dilation (FMD) and Nail Fold Capillaroscopy (NFC)], the patients are being investigated for endothelial dysfunction. Venous blood sample (15 ml) is being collected for routine investigations and assay of biochemical endothelial markers through Flow Cytometry. The patients will be followed up at 12 months and 24 months after the recruitment to look for any change from baseline period. DISCUSSION This study will able to provide a better understanding of the epidemiology of endothelial dysfunction and associated subclinical cardiovascular co-morbidity in childhood NS. Findings on characterization of prevalence of endothelial dysfunction and subclinical markers may be used to design future randomized controlled trials for evaluating the efficacy of preventive and therapeutic interventions in reducing the incidence of cardiovascular disease.
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Affiliation(s)
- S K Patnaik
- Department of Pediatrics, Army Hospital Research and Referral , Delhi, India.
| | - P Kumar
- Department of Pediatrics, Army Hospital Research and Referral , Delhi, India
| | - M Bamal
- Department of Pediatrics, Army Hospital Research and Referral , Delhi, India
| | - S Patel
- Department of Pediatrics, Army Hospital Research and Referral , Delhi, India
| | - M P Yadav
- Department of Pediatrics, Army Hospital Research and Referral , Delhi, India
| | - V Kumar
- Department of Pediatrics, Army Hospital Research and Referral , Delhi, India
| | - A Sinha
- Division of Pediatric Nephrology and ICMR Center for Advanced Research In Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - A Bagga
- Division of Pediatric Nephrology and ICMR Center for Advanced Research In Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M Kanitkar
- Armed Forced Medical College, Pune, India
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13
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Sethna CB, Meyers KEC, Mariani LH, Psoter KJ, Gadegbeku CA, Gibson KL, Srivastava T, Kretzler M, Brady TM. Blood Pressure and Visit-to-Visit Blood Pressure Variability Among Individuals With Primary Proteinuric Glomerulopathies. Hypertension 2017; 70:315-323. [PMID: 28652469 DOI: 10.1161/hypertensionaha.117.09475] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/13/2017] [Accepted: 05/25/2017] [Indexed: 12/19/2022]
Abstract
Hypertension and blood pressure variability (BPV; SD and average real variability) in primary proteinuric glomerulopathies are not well described. Data were from 433 participants in the NEPTUNE (Nephrotic Syndrome Study Network). Hypertensive BP status was defined as previous history of hypertension or BP ≥140/90 mm Hg for adults/≥95th percentile for children at baseline. BPV was measured in participants with ≥3 visits in the first year. Two-hundred ninety-six adults (43 years [interquartile range, 32-57.8 years], 61.5% male) and 147 children (11 years [interquartile range, 5-14 years], 57.8% male) were evaluated. At baseline, 64.8% of adults and 46.9% of children were hypertensive. Histological diagnosis was associated with hypertensive status in adults (P=0.036). In adults, hypertensive status was associated with lower hazard of complete remission (hazard ratio, 0.36; 95% confidence interval, 0.19-0.68) and greater hazard of achieving the composite end point (end-stage renal disease or estimated glomerular filtration rate decline >40%; hazard ratio, 4.1; 95% confidence interval, 1.4-12). Greater systolic and diastolic SD and average real variability were also associated with greater hazard of reaching the composite end point in adults (all P<0.01). In children, greater BPV was an independent predictor of composite end point (determined by systolic SD and average real variability) and complete remission (determined by systolic and diastolic average real variability; all P<0.05). Hypertensive status was common among adults and children enrolled in NEPTUNE. Differences in hypertensive status prevalence, BPV, and treatment were found by age and histological diagnosis. In addition, hypertensive status and greater BPV were associated with poorer clinical outcomes.
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Affiliation(s)
- Christine B Sethna
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.).
| | - Kevin E C Meyers
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.)
| | - Laura H Mariani
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.)
| | - Kevin J Psoter
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.)
| | - Crystal A Gadegbeku
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.)
| | - Keisha L Gibson
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.)
| | - Tarak Srivastava
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.)
| | - Matthias Kretzler
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.)
| | - Tammy M Brady
- From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.)
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14
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Skrzypczyk P, Przychodzień J, Mizerska-Wasiak M, Kuźma-Mroczkowska E, Okarska-Napierała M, Górska E, Stelmaszczyk-Emmel A, Demkow U, Pańczyk-Tomaszewska M. Renalase in Children with Glomerular Kidney Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1021:81-92. [PMID: 28405891 DOI: 10.1007/5584_2017_22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Studies suggest that renalase, a renal catecholamine-inactivating enzyme, plays a major role in the pathogenesis of kidney and cardiovascular diseases in adults. This study seeks to determine the role of renalase in children with glomerular kidney diseases. We evaluated the serum renalase, arterial stiffness, intima-media thickness, blood pressure, and clinical and biochemical parameters in 78 children (11.9 ± 4.6 years of age) with glomerulopathies such as idiopathic nephrotic syndrome (40 cases), IgA nephropathy (12 cases), Henoch-Schönlein nephropathy (12 cases), and other glomerulopathies (14 cases). The control group consisted of 38 healthy children aged 11.8 ± 3.3 years. The mean renalase was 25.74 ± 8.94 μg/mL in the glomerulopathy group, which was not significantly different from the 27.22 ± 5.15 in the control group. The renalase level did not differ among various glomerulopathies either. However, proteinuric patients had a higher renalase level than those without proteinuria (28.43 ± 11.71 vs. 24.05 ± 6.23, respectively; p = 0.03). In proteinuric patients, renalase correlated with daily proteinuria. In the entire glomerulopathy group, renalase correlated with age, systolic central blood pressure (BP), diastolic peripheral and central BP, mean peripheral and central BP; peripheral diastolic BP Z-score, glomerular filtration rate, cholesterol, triglycerides, and pulse wave velocity. We conclude that in children with glomerulopathies renalase, although basically not enhanced, may underlie blood pressure elevation and arterial damage.
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Affiliation(s)
- Piotr Skrzypczyk
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland.
| | - Joanna Przychodzień
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | - Małgorzata Mizerska-Wasiak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | - Elżbieta Kuźma-Mroczkowska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | | | - Elżbieta Górska
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Pańczyk-Tomaszewska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
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15
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Menéndez Valladares P, Arrobas Velilla T, Bermúdez de la Vega JA, Romero Pérez MDM, Fabiani Romero F, González Rodríguez C. [Increased lipoprotein(a) in a paediatric patient associated with nephrotic syndrome]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2016; 28:227-229. [PMID: 27623226 DOI: 10.1016/j.arteri.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
A common complication in paediatric patients with nephrotic syndrome (NS) is hyperlipidaemia. About 20% of children do not respond to treatment with corticosteroids, presenting with a cortico-resistant NS (CRNS), which can progress to kidney failure. It has been observed that paediatric patients with CRNS have an elevated low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and triglycerides levels, as well as elevated Lipoprotein-a [Lp (a)] levels. The case is presented of a 5 year old boy, diagnosed with CRNS, presenting with dyslipidaemia with increased LDL-c, Apo-B100, and Lp(a) levels. After the poor prognosis of the renal function, immunosuppressant treatment was started with tacrolimus and atorvastatin to control dyslipidaemia. Although tacrolimus causes an elevation of total cholesterol and LDL-c, the significant alterations of the children lipid profile suggest the existence of a high cardiovascular risk. In these cases, it would be interesting to have reference values in children in our health area.
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Affiliation(s)
- Paloma Menéndez Valladares
- Laboratorio de Nutrición y RCV, Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Teresa Arrobas Velilla
- Laboratorio de Nutrición y RCV, Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España; Facultad de Medicina, Universidad Autónoma de Chile, Providencia, Región Metropolitana, Chile
| | | | - María Del Mar Romero Pérez
- Endocrinología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Fernando Fabiani Romero
- Laboratorio de Nutrición y RCV, Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Concepción González Rodríguez
- Laboratorio de Nutrición y RCV, Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
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