Echocardiographic assessment of pediatric lupus nephritis and its correlation with disease activity in a tertiary care hospital

Abstract

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with multisystem involvement. Lupus Nephritis (LN) is the most serious presentation. Cardiovascular complications in SLE and LN can cause significant morbidity and mortality. An echocardiographic (ECHO) screening allows early detection and intervention, so that early treatment can be provided.

Method

This cross-sectional analytical study evaluated 50 children with LN at the Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to July 2023. All patients fulfilled the Systemic Lupus International Collaborating Clinics (SLICC, 2012) criteria for SLE diagnosis and had evidence of renal involvement. Cardiac evaluation was performed by color doppler echocardiography. Systemic lupus erythematosus disease activity index (SLEDAI) was used to see the disease activity.

Results

The mean age of presentation was 12.4 ± 2.79 years, with a male-to-female ratio of 1:3. Cardiac abnormalities were found in 20 patients (40%), with tricuspid regurgitation being the most frequent (38%), followed by pericardial effusion (28%), pulmonary hypertension (24%), and mitral, aortic and pulmonary regurgitation in descending order. Abnormal echocardiographic findings were significantly associated with higher SLEDAI scores and lower C3 levels.

Conclusions

Cardiac abnormalities are prevalent in pediatric LN and valvular dysfunction particularly tricuspid regurgitation being the most common followed by pericardial effusion and pulmonary hypertension. These abnormalities correlate with higher disease activity and lower C3 levels, emphasizing the critical need for routine echocardiographic screening for early detection and management.