ESPN 50th Annual Meeting

ESPN 2017


 
Kidneys involvement in children with systemic diseases: contribution of cardiovascular comorbidity.
INA KAZYRA NADEZHDA ABROSIMAVA 2 MOHSEN HOSHAYARIKHANI 1 Farida FOTOVATKASBSHIRAZI 1

1- BELARUS STATE MEDICAL UNIVERSITY
2- 2ND CHILDRENS HOSPITAL
 
Introduction:

Despite the significant progress achieved in the treatment and outcome of children with renal involvement due to systemic diseases, many questions remain in the early detection of cardiovascular complications (CVC), the leading cause of death in these patients in adulthood. This study is contributed to find out the risk of developing CVC in patients with lupus(LN), IgA Henoch-Schonlein purpura nephritis (HSPN) and ANCA-associated nephritis. 

Material and methods:

 59 children were enrolled: 27 with LN (2 boys, 7-17 yrs), 27 with HSPN (14 boys, 3-17 yrs) and 5 with ANCA-nephritis (2 boys, 6-17 yrs), all had morphological verification of nephritis. As a control 37 healthy children were examined. 24 hours monitoring of blood pressure(BP), ECHO-CG, carotid intima media thickness(cIMT), left ventricles mass index (LVMI), relative thickness of left ventricles wall (RTLV), body mass index (BMI), serum lipids levels, glucose, uric acide, eGFR and markers of vascular endothelial dysfunction VEGF and TGF1β were measured.

Results:

 Arterial hypertension(AG) was observed in 43/59 (73%) of children with glomerulopathies: in 23/27 of LN (86%), in 100% of ANCA and 13/27 HSPN (48%), required of an average 3 hypotensive drugs. Dilatations of the LV in 24%, reduced ejection fraction in 2.1% of all patients were seen. LVMI, RTLV, BMI and cIMT were higher compared with healthy (p<0.05). In patients with nephritis serum concentration of VEGF and TGF1β correlated with AG. The mean serum cholesterol level was 5.8 mmol/l in LN, 6.94 in ANCA and 5.16 in HSPN (p<0.05), lipoproteins of low and very low density prevailed. The mean serum glucose level was not significantly higher than in healthy, in contrast to the level of uric acid (p<0.05), especially in ANCA nephritis (p<0.01).

Conclusions:

 In patients with LN, HSPN and ANCA-associated nephritis abnormalities in serum lipids level were correlated with disease activity and duration, younger age of diagnosis, mean cIMT, eGFR, increased systolic and diastolic BP, BMI, LVMI, RTLV, concentration of VEGF and TGF1β.  Such patients are at high risk of early development of cardiovascular complications requiring early correction.