Cardiorenal interactions in patients with juvenile idiopathic arthritis
DOI:
https://doi.org/10.14739/2310-1210.2024.5.302775Keywords:
kidney function, morphofunctional indicators of the heart, cardiorenal syndrome, juvenile idiopathic arthritis, childrenAbstract
As early as the first stages of rheumatic diseases in children, a number of pathological changes occur with the involvement of many organs and systems in the process. In children with juvenile idiopathic arthritis (JIA), decreased adaptability of the cardiovascular system is detected in 17.0–20.0 % of cases. 36.9 % of children with JIA develop renal lesions. Thus, inflammation underlies the interaction between pathological mechanisms of renal and heart failure in patients with rheumatic diseases.
The aim of the work is to identify the characteristics of the interaction between main morphofunctional parameters of the cardiovascular system and kidneys in children with JIA, and the factors that give rise to the formation and worsening of these disorders.
Materials and methods. 152 patients aged 13.42 ± 0.22 years with JIA were examined. Renal functions were examined based on the levels of creatinine, urea, albuminuria, urine specific gravity, glomerular filtration rate. To determine the morphofunctional parameters of the heart, ultrasound examinations of both left and right ventricles were performed.
Results. In children with JIA, the functional parameters of the kidneys almost do not differ from those of the control group, with the exception of albuminuria, which is significantly higher in children of the main group and increases with the process activity progression. Morphofunctional analysis of the cardiac parameters has shown a decrease in the stroke volume of the left ventricle (51.83 ± 1.57 ml against 57.86 ± 2.54 ml, р < 0.05) with preserved ejection fraction and a significant increase in the right ventricle volumes both diastolic (34.54 ± 1.51 ml against 22.45 ± 2.11 ml, p < 0.001) and systolic (19.15 ± 0.96 ml against 10.18 ± 1.14 ml, p < 0.001), as well as stroke volume (15.39 ± 0.84 ml against 12.21 ± 1.05 ml, p < 0.01), with a significant decrease in its ejection fraction (45.04 ± 1.44 % against 56.06 ± 1.59 %, p < 0.001).
Conclusions. Renal functional parameters are within normal values, but the level of albuminuria is significantly higher and increases with the process activity progression in children with JIA. The morphofunctional parameters of the left ventricle correspond to the control ones, but there is an increase in the right ventricle volume with a significant decrease in its ejection fraction. A decrease in the myocardial pumping function of the right ventricle is accompanied by a decrease in renal blood supply which leads to the development of cardiorenal syndrome type 5 in JIA children.
References
Thomas KN, Aggarwal A. Childhood rheumatic diseases: bites not only the joint, but also the heart. Clin Rheumatol. 2023;42(10):2703-15. doi: https://doi.org/10.1007/s10067-023-06621-9
López-Villanueva RF, Valencia-Pacheco G, Zapata-Vázquez R, López-Suárez R, Castro-Sansores C. Follow-up of clinical activity and accumulated organic damage in a cohort of patients with systemic lupus erythematosus from the Yucatán Peninsula, Mexico (1995-2016). Reumatol Clin (Engl Ed). 2023;19(2):106-13. doi: https://doi.org/10.1016/j.reumae.2021.12.002
Bogmat LF, Shevchenko NS, Holovko TO, Nikonova VV, Bessonova IN, Akhnazariants EL, et al. [Comorbidity in children with rheumatic diseases: literature review and 10-year experience of own research]. Child`s health. 2023;18(4):297-304. Ukrainian. doi: https://doi.org/10.22141/2224-0551.18.4.2023.1603
DeMizio DJ, Geraldino-Pardilla LB. Autoimmunity and Inflammation Link to Cardiovascular Disease Risk in Rheumatoid Arthritis. Rheumatol Ther. 2020;7(1):19-33. doi: https://doi.org/10.1007/s40744-019-00189-0
Samar Tharwat, El-Gazzar II, Rawhya El Shereef, Ismail F, Ali F, Taha H, et al. Damage in rheumatic diseases: Contemporary international standpoint and scores emerging from clinical, radiological and machine learning. Egypt Rheumatol. 2024;46(1):12-8. doi: https://doi.org/10.1016/j.ejr.2023.11.002
Chen J, Norling LV, Cooper D. Cardiac Dysfunction in Rheumatoid Arthritis: The Role of Inflammation. Cells. 2021;10(4):881. doi: https://doi.org/10.3390/cells10040881
Dijkshoorn B, Raadsen R, Nurmohamed MT. Cardiovascular Disease Risk in Rheumatoid Arthritis Anno 2022. J Clin Med. 2022;11(10):2704. doi: https://doi.org/10.3390/jcm11102704
Fazeli MS, Khaychuk V, Wittstock K, Breznen B, Crocket G, Pourrahmat MM, et al. Cardiovascular Disease in Rheumatoid Arthritis: Risk Factors, Autoantibodies, and the Effect of Antirheumatic Therapies. Clin Med Insights Arthritis Musculoskelet Disord. 2021;14:11795441211028751. doi: https://doi.org/10.1177/11795441211028751
Popescu D, Rezus E, Badescu MC, Dima N, Seritean Isac PN, Dragoi I-T, et al. Cardiovascular Risk Assessment in Rheumatoid Arthritis: Accelerated Atherosclerosis, New Biomarkers, and the Effects of Biological Therapy. Life. 2023;13(2):319. doi: https://doi.org/10.3390/life1302031910
Hannawi SM, Hannawi H, Al Salmi I. Cardiovascular Risk in Rheumatoid Arthritis: Literature Review. Oman Med J. 2021;36(3):e262. doi: https://doi.org/10.5001/omj.2021.25
Yazdani K, Xie H, Avina-Zubieta JA, Zheng Yu, Abrahamowicz M, Lacaille D. Has the excess risk of acute myocardial infarction in rheumatoid arthritis relative to the general population declined? A population study of trends over time. Semin Arthritis Rheum. 2021;51(2):442-9. doi: https://doi.org/10.1016/j.semarthrit.2021.03.003
Mal K, Kumar R, Mansoor F, Kaur N, Kumar A, Memon S, et al. Risk of Major Adverse Cardiovascular Events in Patients With Rheumatoid Arthritis. Cureus. 2020;12(12):e12246. doi: https://doi.org/10.7759/cureus.12246
Rostami S, Hoff M, Dalen H, Hveem K, Videm V. Genetic risk score associations for myocardial infarction are comparable in persons with and without rheumatoid arthritis: the population-based HUNT study. Sci Rep. 2020;10(1):20416. doi: https://doi.org/10.1038/s41598-020-77432-0
Hanaoka H, Kikuchi J, Hiramoto K, Saito S, Kondo Y, Kaneko Y. Decreased chronic kidney disease in rheumatoid arthritis in the era of biologic disease-modifying anti-rheumatic drugs. Clin Kidney J. 2022;15(7):1373-8. doi: https://doi.org/10.1093/ckj/sfac036
Oweis AO, Alawneh KM, Alshelleh SA, Alnaimat F, Alawneh D, Zahran DJ. Renal dysfunction among rheumatoid arthritis patients: A retrospective cohort study. Ann Med Surg (Lond). 2020;60:280-4. doi: https://doi.org/10.1016/j.amsu.2020.11.011
Tyczyńska KM, Augustyniak-Bartosik H, Świerkot J. Rheumatoid arthritis – medication dosage in chronic kidney disease. Reumatologia. 2023;61(6):481-91. doi: https://doi.org/10.5114/reum/177005
Monova DV, Todorov T, Monov S. Kidney involvement in patients with rheumatoid arthritis. Nephrology Dialysis Transplantation. 2023;38(1):gfad063c_2776. doi: https://doi.org/10.1093/ndt/gfad063c_2776
Kochi M, Kohagura K, Shiohira Y, Iseki K, Ohya Y. Chronic kidney disease, inflammation, and cardiovascular disease risk in rheumatoid arthritis. J Cardiol. 2018;71(3):277-83. doi: https://doi.org/10.1016/j.jjcc.2017.08.008
Petra E, Zoidakis J, Vlahou A. Protein biomarkers for cardiorenal syndrome. Expert Rev Proteomics. 2019;16(4):325-36. doi: https://doi.org/10.1080/14789450.2019.1592682
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-39. doi: https://doi.org/10.1016/j.jacc.2008.07.051
Rangaswami J, Bhalla V, Blair JE, Chang TI, Costa S, Lentine KL, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. 2019;139(16):e840-e878. doi: https://doi.org/10.1161/CIR.0000000000000664
Cardio-Renal Connections in Heart Failure and Cardiovascular Disease [Internet]. NHLBI, NIH. 2004 [cited 2024 Aug 21]. Available from: https://internet-prod.nhlbi.nih.gov/events/2004/cardio-renal-connections-heart-failure-and-cardiovascular-disease
Mitsas AC, Elzawawi M, Mavrogeni S, Boekels M, Khan A, Eldawy M, et al. Heart Failure and Cardiorenal Syndrome: A Narrative Review on Pathophysiology, Diagnostic and Therapeutic Regimens-From a Cardiologist’s View. J Clin Med. 2022;11(23):7041. doi: https://doi.org/10.3390/jcm11237041
Georgopoulou T, Petrakis I, Dermitzaki K, Pleros C, Drosataki E, Aletras G, et al. Cardiorenal Syndrome: Challenges in Everyday Clinical Practice and Key Points towards a Better Management. J Clin Med. 2023;12:4121. doi: https://doi.org/10.3390/jcm12124121
Ceravolo G, Macchia T, Cuppari C, Dipasquale V, Gambadauro A, Casto C, et al. Update on the Classification and Pathophysiological Mechanisms of Pediatric Cardiorenal Syndromes. Children (Basel). 2021;8(7):528. doi: https://doi.org/10.3390/children8070528
Shevchenko NS, Bohmat LF, Holovko TO, Demianenko MV. [Adaptive capacity of the cardiovascular system in children with rheumatic diseases and comorbid conditions]. Pathologia. 2019;16(1):99-105. Ukrainian. doi: https://doi.org/10.14739/2310-1237.2019.1.166395
Pradhan SK, Adnani H, Safadi R, Yerigeri K, Nayak S, Raina R, et al. Cardiorenal syndrome in the pediatric population: A systematic review. Ann Pediatr Cardiol. 2022;15(5-6):493-510. doi: https://doi.org/10.4103/apc.apc_50_22
Borysova TP, Samsonenko, SV. [Glomerular filtration rate in children with juvenile idiopathic arthritis]. Child`s health. 2022;17(1):1-6. Ukrainian. doi: https://doi.org/10.22141/2224-0551.17.1.2022.1484
Bogmat L, Shevchenko N, Nikonova V, Holovko T, Bessonova I, Fadeeva A. [Dynamics of kidney disorders in children with juvenile idiopathic arthritis taking into account therapy resume]. The Journal of V. N. Karazin Kharkiv National University. Series «Medicine». 2022;44:35-43. doi: https://doi.org/10.26565/2313-6693-2022-44-02
Song P, Wang M, Chang X, Wang J, Wei W, An L. Prevalence and associated factors of impaired renal function in Chinese children: The China Health and Nutrition Survey. Nephrology (Carlton). 2019;24(2):195-201. doi: https://doi.org/10.1111/nep.13178
Ajibowo AO, Okobi OE, Emore E. Soladoye E, Sike CG, Odoma VA, et al. Cardiorenal Syndrome: A Literature Review. Cureus. 2023;15(7):e41252. doi: https://doi.org/10.7759/cureus.41252
Buliga-Finis ON, Ouatu A, Badescu MC, Dima N, Tanase DM, Richter P, et al. Beyond the Cardiorenal Syndrome: Pathophysiological Approaches and Biomarkers for Renal and Cardiac Crosstalk. Diagnostics. 2022;12(4):773. doi: https://doi.org/10.3390/diagnostics12040773
Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A. Rheumatoid arthritis: Extra-articular manifestations and comorbidities. Autoimmun Rev. 2021;20(4):102776. doi: https://doi.org/10.1016/j.autrev.2021.102776
Ikdahl E, Stensrud MJ. Re-evaluating the mythical divide between traditional and novel cardiovascular risk factors in rheumatoid arthritis. RMD Open. 2024;10:e003954. doi: https://doi.org/10.1136/rmdopen-2023-003954
Raina R, Nair N, Chakraborty R, Nemer L, Dasgupta R, Varian K. An Update on the Pathophysiology and Treatment of Cardiorenal Syndrome. Cardiol Res. 2020;11(2):76-88. doi: https://doi.org/10.14740/cr955
Bedeković D, Bošnjak I, Bilić-Ćurčić I, Kirner D, Šarić S, Novak S. Risk for cardiovascular disease development in rheumatoid arthritis. BMC Cardiovasc Disord. 2024;24(1):291. doi: https://doi.org/10.1186/s12872-024-03963-3
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
