Evaluation of cardiovascular morbidities in children and adolescents with lupus nephritis from south India: A cross-sectional analytical study

BackgroundPremature atherosclerosis and cardiovascular morbidity are known in adults with Systemic Lupus Erythematosus (SLE); however, there is paucity of data in Indian children with lupus nephritis (LN), who may be at higher cardiovascular risk due to ethnic differences.MethodsThis cross-sectional study was conducted at the pediatric nephrology clinic of a referral hospital in south India. Forty children with LN >1 year disease duration and 40 healthy-controls were enrolled. Brachial artery flow-mediated dilatation (FMD), carotid intima medial thickness (cIMT), and echocardiography for left ventricular (LV) mass, LV systolic and diastolic function, and global-longitudinal-strain (GLS) were done.ResultsMean age at SLE and LN diagnosis were 10.07 years and 10.68 years respectively, with median LN disease duration of 3.2 years. Class 3 and Class 4 LN accounted for 67.5% of the cases. Overall, 6 (15%) LN cases had concentric LVH, while 4 (10%) had biplane ejection fraction≤ 55%. Mean resting brachial artery diameter was lower in cases (<i>n</i> = 40) than age and sex-matched healthy-controls (<i>n</i> = 40) (2.7 mm vs 2.9 mm, <i>p 0.010</i>), although median proportionate change in FMD was comparable [13.84% (8.17%, 20.31%) versus 14.49% (12.21%, 17.24%); <i>p 0.413</i>]. However, proportionate change in FMD <10% was more prevalent in cases vs controls (35% vs 10%, p 0.007). Cardiac assessments showed higher A-wave velocity (69.03 ± 18.0 cm/s vs 58.64 ± 11.93 cm/s, <i>p 0.003</i>) and lower E/A ratio (1.56 ± 0.49 vs 1.80 ± 0.44, <i>p 0.030</i>) in cases vs controls; with elevated medial a' velocity (8.98 ± 2.01 vs 7.94 ± 2.12 cm/s, <i>p 0.030</i>). Pulmonary venous Doppler revealed shorter atrial reversal duration (85.82 ± 18.7 vs 102.25 ± 17.8 ms, <i>p 0.001</i>) and reduced A-wave duration (118.08 ± 19.73 vs 128.67 ± 20.27 ms, <i>p 0.023</i>) among cases. GLS was lower in cases (-21.59 ± 3.06% vs -22.95 ± 2.38%, <i>p 0.030</i>), and median LV mass was higher in cases vs controls (92.7 g vs 72.1 g, <i>p < .001</i>).ConclusionSouth Indian children with LN of >1 year disease duration demonstrate significant cardiovascular comorbidities, including evidence of endothelial dysfunction, as well as LV systolic and diastolic dysfunction.