Vascular Remodelling in Idiopathic Nephrotic Syndrome with Administration of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers

Pediatric nephrotic syndrome (NS) significantly increases cardiovascular risk, primarily through activation of the renin-angiotensin-aldosterone system (RAAS) and chronic inflammation. This study aimed to evaluate the relationship between serum aldosterone and interleukin 6 (IL-6) levels with carotid intima-media thickness (CIMT) in children with steroid-sensitive (SSNS) and steroid-resistant NS (SRNS), before and after treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB). This prospective, single-arm pretest–posttest study included 32 children aged 2–18 years with idiopathic NS at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Participants received lisinopril and valsartan for 12 weeks. Serum aldosterone was quantified by liquid chromatography-tandem mass spectrometry, IL-6 by electrochemiluminescence immunoassay, and CIMT by high-resolution B-mode Doppler ultrasound. Data were analyzed using SPSS version 26.0, including Shapiro-Wilk normality testing, correlation analyses, and multivariate linear regression, with statistical significance set at p<0.05. CIMT decreased significantly after treatment (0.13±0.04 cm to 0.06±0.01 cm; p<0.001). Serum aldosterone and IL-6 did not change significantly. Multivariate regression identified steroid resistance as associated with CIMT change, while aldosterone and IL-6 showed no significant independent effects.