Predictors of thickened carotid intima media thickness among well controlled lupus nephritis patients in a Malaysian tertiary centre

Abstract

summary Objectives. To investigate the prevalence of thickened carotid intima media thickness (CIMT) and its associated risk factors in patients with lupus nephritis (LN) who were in remission.Methods. This was a cross sectional study in which consecutive LN patients who were in remission and attending our Nephrology/SLE Clinic were included. Their demographic profile, traditional cardiovascular risk factors and treatment medications were evaluated by clinical interview and review of medical records. Carotid intima media thickness (CIMT) was measured using B Mode carotid ultrasonography. CIMT was considered to be abnormally thickened if it exceeded the 75 th percentile matched for age-and sex-matched normal controls. The associated factors for thickened CIMT were examined. Results. A total of 39 patients with a mean remission duration of 29±24.3 months and on a mean prednisolone dose of 9.10±7.83 mg daily completed the study. Six patients (15.4%) had thickened CIMT. On univariate analysis, male gender, patient age, older age at diagnosis, higher serum CRP levels, greater proteinuria and higher mean cumulative azathioprine dose were associated with thickened CIMT (P<0.05). Lower mean cumulative doses of cyclosporine A (CyA) and mycophenolic acid (MPA) (P<0.05) each were associated with thickened CIMT. Using regression analysis, the associated factors of CIMT were older age at diagnosis and proteinuria. Conclusions. Lupus factors particularly age at diagnosis and proteinuria were the associated factors of thickened CIMT. Larger prospective trials are indicated to confirm our findings.

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“…In our setting, where majority of patients are women of childbearing age, the use of biologics was observed in clinical practice to be of great value compared to the conventional immunosuppressive treatment which has significant side effect profile such as infertility that's is no easily accepted by large number of patients Despite that the management of the disease is still a clinical challenge for the treating physicians as many aspects regarding the disease pathogenesis, clinical picture and outcomes remain to be elucidated. Moreover, SLE patients have many traditional risk factors for cardiovascular diseases but even more worrying they tend to have an alarming risk of non-traditional risk factors such us disease activity and chronic inflammation [14,15]. All these risk factors need to be managed appropriately to further reduce mortality and morbidity.…”

Relationship between urinary protein changes in lupus nephritis and renal pathology

“…This mouse line can present several lupus nephritis clinical symptoms such as proteinuria, hematuria, and impaired renal function. In particular, the mechanism of kidney damage is roughly the same as that in humans (Li et al, 2012;Shaharir et al, 2012). Therefore, the backcross mouse model is widely used in lupus nephritis and clinical experiments.…”