Acute myocardial infarction in a young boy with nephrotic syndrome: a case report and review of the literature

A 7-year-old boy with a 5-year history of steroidunresponsive nephrotic syndrome due to minimal change disease presented with acute myocardial infarction. Angiography was suggestive of a dissected atherosclerotic plaque at the initial and mid portions of the right coronary artery, as well as a lesion in the mid portion of the circumflex artery. The child had a long history of extreme hypercholesterolemia and hypertriglyceridemia, along with apolipoprotein-E 4/3 phenotype. The mother, who also has apolipoprotein-E 4/3 phenotype, has mild hypercholesterolemia. The case suggests that children with long-lasting nephrotic syndrome and even mild familial propensity for hyperlipidemia may be at increased risk for ischemic cardiovascular events. The literature is reviewed regarding the relationship between nephrotic syndrome and the incidence of ischemic heart disease.