Status of the coronary arteries in the nephrotic syndrome: Analysis of 20 necropsy patients aged 15 to 35 years to determine if coronary atherosclerosis is accelerated

Abstract

This report describes the status of the major extramural (epicardial) coronary arteries in 20 patients (average age = 24 years) with the nephrotic syndrome (from systemic lupus erythematosus in 13 patients, diabetes mellitus in four and chronic idiopathic glomerulonephritis in three), and compares the clinical and morphologic observations to those in 14 control subjects (average age = 29 years). Both patients with the nephrotic syndrome and control subjects ranged in age from 15 to 39 years. The 20 patients with the nephrotic syndrome had significantly more coronary luminal narrowing by atherosclerotic plaques than did the control subjects. The lumens of one or more of the four major coronary arteries were narrowed >75 per cent in cross-sectional area in eight (40 per cent) of the 20 nephrotic patients and in none of the 14 control subjects. This difference in degree of coronary disease was even more striking when the per cent of narrowing in the entire coronary tree was examined: of the 290.5 cm of coronary artery examined in the 20 nephrotic patients, the lumen in 88 cm (30 per cent) was >50 per cent narrowed in cross-sectional area, whereas of 288 cm of coronary artery examined in the 14 control subjects, the lumen in only 5.5 cm (2 per cent) was narrowed to this degree. Although the cause of the accelerated coronary atherosclerosis in our nephrotic patients is uncertain, hypercholesterolemia, systemic hypertension, corticosteroid therapy and increased clotting tendencies probably all contributed to this acceleration.