Abstract
Background: Evidence suggests that proteinuric diseases, such as primary or secondary glomerulonephritis, increase cardiovascular risk, but few studies confirmed this association. Methods: This is a cross-sectional, observational study on 32 patients, 17 with Primary Glomerulonephritis (PG) and 15 with Lupus Glomerulonephritis (LG). The control group consisted of 32 healthy individuals. Intima-media thickness (IMT) of the left common carotid artery, carotid bifurcation and internal carotid artery was measured by ultrasound. Left ventricular myocardial deformation was assessed by the use of the Global Circumferential Strain (GCS) and the Global Longitudinal Strain (GLS) following 2-Dimensional (2D) echocardiography in all participants. Results: Patients with glomerulonephritis in both groups showed significantly lower GLS compared with controls (p=0.0005). There was also a significant difference in common carotid IMT values between the LG and GP group (0.45±0.09 vs. 0.58±0.17 mm, respectively; p=0.01), but there was no difference with the control group. In patient group (n=32), a significantly positive correlation was observed between C-reactive protein and proteinuria (r=0.98; p<0.0001), whereas negative correlations were found between common carotid IMT and creatinine clearance (r=-0.97; p<0.0001) and between carotid bifurcation IMT and phosphate levels (r=-0.97; p<0.0001) Conclusion: Subclinical systolic myocardial dysfunction is present early in the course of glomerular disease. The use of 2D GLS revealed that LG and PG patients with no cardiovascular symptoms or history and a preserved left ventricle ejection fraction on conventional echocardiography had subclinical reduction in LV global longitudinal systolic function compared with controls.
Highlights
The prevalence of Chronic Kidney Disease (CKD), estimated between 7 and 12.5% in the general population [1]
15 of these patients were affected by lupus glomerulonephritis (LG group) and 17 by primary glomerulonephritis (PG group), consisting of IgA nephropathy (IgAN) (n = 7), membranous glomerulonephritis (MGN) (n = 5), minimal change nephropathy (MCN) (n = 4) and focal and segmental glomerulosclerosis (FSGS) (n = 1)
In the Primary Glomerulonephritis (PG) group, a higher percentage of patients were treated with vitamin D and a lower percentage with steroid and immunosuppressive drugs compared with the Lupus Glomerulonephritis (LG) group
Summary
The prevalence of Chronic Kidney Disease (CKD), estimated between 7 and 12.5% in the general population [1]. The Open Rheumatology Journal, 2019, Volume 13 87 sufficient to explain the elevated CV morbidity and mortality in CKD [9] In this context, there are emerging risk factors of this population (such as systemic inflammation, mineral and bone disorders, hyperhomocysteinemia and anemia) that are considered to contribute to their CV risk [10 - 14]. The presence of albuminuria is associated with CV disease and it is considered a predictor of all-cause mortality [15] Proteinuric diseases, such as primary or secondary glomerulonephritis, seem to be correlated with increased CV risk, but few studies confirmed this association. Conventional echocardiographic studies are not able to identify alterations in subclinical CV disease or to discriminate between patients at low and high CV risk For this reason, it is important to conduct studies evaluating cardiac performance as a marker of early diagnosis of CV disease. Evidence suggests that proteinuric diseases, such as primary or secondary glomerulonephritis, increase cardiovascular risk, but few studies confirmed this association
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