Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Hypertension on Childhood-onset Systemic Lupus Erythematous in a Tertiary Medical Center in Korea

  • Kim, Jeong Yeon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Heeyeon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2020.08.31
  • Accepted : 2020.09.21
  • Published : 2020.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to evaluate the prevalence, clinical characteristics, and long-term clinical effects of hypertension in Korean childhood-onset systemic lupus erythematous (SLE) patients. Methods: The medical records of SLE patients, diagnosed by 2019 SLE European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria, who visited Samsung Medical Center from January 2009 to May 2019 were reviewed. Disease activity and long-term damage were evaluated using the Modified Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the Pediatric Systemic Lupus International Collaborating Clinics/ACR Damage Index (Ped-SDI), respectively. The sex-, age- and height-blood pressure standards recommended by the American Academy of Pediatrics 2017 guideline was used to define hypertension. Results: A total of 32 patients were enrolled in this study. The median follow-up duration was 7.3 years and females were predominant. The median ages at SLE and hypertension diagnoses were 14.2 and 14.3 years, respectively. The biopsy-proven lupus nephritis was detected in 90.6% and 37.5% were class IV. During the follow-up, 12 patients (37.5%) had hypertension. Among them, 2 patients had 3 episodes of posterior reversible encephalopathy syndrome and 5 patients had left ventricular hypertrophy (LVH). Univariate analysis showed baseline hypertension was significantly correlated with a lower estimated glomerular filtration rate, higher body mass index and SLEDAI at baseline. The development of hypertension during the follow-up was significantly correlated with obesity, LVH, and higher Ped-SDI. Conclusion: Our study revealed that hypertension in pediatric SLE is associated with obesity and renal function at SLE diagnosis and could affect long-term damage.

Keywords

References

  1. Gandelman JS, Khan OA, Shuey MM, Neal JE, McNeer E, Dickson A, et al. Increased Incidence of Resistant Hypertension in Patients With Systemic Lupus Erythematosus: A Retrospective Cohort Study. Arthritis Care Res (Hoboken) 2020;72:534-43. https://doi.org/10.1002/acr.23880
  2. Avar Aydin PO, Shan J, Brunner HI, Mitsnefes MM. Blood pressure control overtime in childhood-onset systemic lupus erythematous. Lupus 2018;27:657-64. https://doi.org/10.1177/0961203317751061
  3. Chan, PC, Yu, CH, Yeh, KW, Horng, JT, Huang, JL. Comorbidities of pediatric systemic lupus erythematosus: A 6-year nationwide population-based study. J Microbiol Immunol Infect 2016;49:257-63. https://doi.org/10.1016/j.jmii.2014.05.001
  4. Al-Herz, A, Ensworth, S, Shojania, K, Esdaile, JM. Cardiovascular risk factor screening in systemic lupus erythematosus. J Rheumatol 2003;30:493-6.
  5. Munguia-Realpozo P, Mendoza-Pinto C, Sierra Benito C, Escarcega RO, Garcia-Carrasco M, Mendez Martinez S, et al. Systemic lupus erythematosus and hypertension. Autoimmun Rev 2019;18:102371. https://doi.org/10.1016/j.autrev.2019.102371
  6. Sabio JM, Vargas-Hitos JA, Martinez-Bordonado J, Navarrete-Navarrete N, Diaz-Chamorro A, Olvera-Porcel C, et al. Relationship between homocysteine levels and hypertension in systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2014;66:1528-35. https://doi.org/10.1002/acr.22340
  7. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol 2019;71:1400-12. https://doi.org/10.1002/art.40930
  8. Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002;29:288-91.
  9. Gutierrez-Suarez R, Ruperto N, Gastaldi R, Pistorio A, Felici E, Burgos-Vargas R, et al. A proposal for a pediatric version of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index based on the analysis of 1,015 patients with juvenile-onset systemic lupus erythematosus. Arthritis Rheum 2006;54:2989-96. https://doi.org/10.1002/art.22048
  10. Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al. The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr 2018;61:135-49. https://doi.org/10.3345/kjp.2018.61.5.135
  11. International Association for the Study of Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney, Australia: World Health Organization Western Pacific Region 2000. [cited 2020 Aug 28] Available from: http://iris.wpro.who.int/handle/10665.1/5379.
  12. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017;140:e20171904. https://doi.org/10.1542/peds.2017-1904
  13. Korean Medical Guideline Information Center. Evidence-based recommendations for hypertension in primary care. 2018. [cited 2020 Aug 28] Available from: http://www.guideline.or.kr/chronic/view.php?number=88.
  14. Khoury PR, Mitsnefes M, Daniels SR, Kimball TR. Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 2009;22:709-14. https://doi.org/10.1016/j.echo.2009.03.003
  15. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233-70. https://doi.org/10.1093/ehjci/jev014
  16. McMahon M, Skaggs BJ, Sahakian L, Grossman J, FitzGerald J, Ragavendra N, et al. High plasma leptin levels confer increased riskof atherosclerosis in women with systemic lupus erythematosus, and areassociated with inflammatory oxidised lipids. Ann Rheum Dis 2011;70:1619-24. https://doi.org/10.1136/ard.2010.142737
  17. Campbell JF, Swartz SJ, Wenderfer SE. Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus. Version 2.F1000Res 2015;4:164. https://doi.org/10.12688/f1000research.6532.2
  18. Hiraki LT, Feldman CH, Liu J, Alarcon GS, Fischer MA, Winkelmayer WC, et al. Prevalence, incidence, and demographics of systemic lupus erythematosus and lupus nephritis from 2000 to 2004 among children in the US Medicaid beneficiary population. Arthritis Rheum 2012;64:2669-76. https://doi.org/10.1002/art.34472
  19. Rizk A, Gheita TA, Nassef S, Abdallah A. The impact of obesity in systemic lupus erythematosus on disease parameters, quality of life, functional capacity and the risk of atherosclerosis. Int J Rheum Dis 2012;15:261-7. https://doi.org/10.1111/j.1756-185X.2011.01698.x
  20. Chaiamnuay S, Bertoli AM, Fernandez M, Apte M, Vila LM, Reveille JD, et al.; LUMINA Study Group. The impact of increased body mass index on systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA XLVI). J Clin Rheumatol 2007;13:128-33. https://doi.org/10.1097/RHU.0b013e3180645865
  21. Chaiamnuay S, Bertoli AM, Roseman JM, McGwin G, Apte M, Duran S, et al. African-American and Hispanic ethnicities, renal involvement and obesity predispose to hypertension in systemic lupus erythematosus: results from LUMINA, a multiethnic cohort (LUMINAXLV). Ann Rheum Dis 2007;66:618-22. https://doi.org/10.1136/ard.2006.059311
  22. Castrejon I, Tani C, Jolly M, Huang A, Mosca M. Indices to assess patientswith systemic lupus erythematosus in clinical trials, longterm observational studies, and clinical care. Clin Exp Rheumatol 2014;32:S85-95.
  23. Shamim R, Farman S, Batool S, Khan SEA, Raja MKH. Association of systemiclupus erythematosus disease activity index score with clinical and laboratory parameters in pediatric onset systemic lupus erythematosus. Pak J Med Sci 2020;36:467-72.
  24. Mulvihill E, Ardoin S, Thompson SD, Zhou B, Yu GR, King E, et al. Elevated serum complement levels and higher gene copy number of complement C4B are associated with hypertension and effective response to statin therapy in childhood-onset systemic lupus erythematosus (SLE). Lupus Sci Med 2019;6:e000333. https://doi.org/10.1136/lupus-2019-000333
  25. Gorostidi M, Sobrino J, Segura J, Sierra C, de la Sierra A, Hernandez del ReyR, et al.; Spanish Society of Hypertension ABPM Registry investigators. Ambulatory blood pressure monitoring in hypertensive patients with highcardiovascular risk: a cross-sectional analysis of a 20,000-patient database in Spain. J Hypertens 2007;25:977-84. https://doi.org/10.1097/HJH.0b013e32809874a2
  26. Parati G, Stergiou G, O'Brien E, Asmar R, Beilin L, Bilo G, et al.; European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014;32:1359-66. https://doi.org/10.1097/HJH.0000000000000221

Cited by

  1. Obesity and chronic kidney disease: prevalence, mechanism, and management vol.64, pp.10, 2021, https://doi.org/10.3345/cep.2021.00108