[Lupus Nephritis As a Factor of Atherosclerosis Risk in Patients with Systemic Lupus Erythematosus]

Aim: To investigate early atherosclerosis (AS) risk factors in patients with systemic lupus erythematosus (SLE) in respect to the presence of lupus nephritis (LN) and antiphospholipid (APL) antibodies.

Material And Methods: We analysed case histories of 137 SLE patients observed in E.M. Tareev clinic from 1970 to 2006. AS manifestations were studied by echocardiography, ultrasonic dopplerography of the peripheral vessels, x-ray methods. AS was considered early if it arose at the age under 55 years. Patients with chronic renal failure were not included in the study.

Results: AS development was seen in 54 (45%) patients, early symptoms appeared at the age of 25-68 years (mean 54 +/- 10 years). In 37 (31%) patients AS symptoms manifested at the age under 55 years. Significant factors of early AS risk were age, hyperlipidemia, arterial hypertension, menopause for women, APL antibodies circulation, stage IV chronic disease of the kidneys, hyperuricemia, higher blood creatinine, mean dose of prednisolone over 15 mg/day, frequent elevation of the level of C-reactive protein. A direct correlation between lupus nephritis or nephrotic syndrome (NS) and early AS was not found. In LN hyperlipidemia occurred more often (p = 0.055), lipids level and NS were not related during its remission. LN patients developed AS more frequently, had lower complement concentration in the end of the study, were treated with prednisolone more intensively than patients free of renal disease (p < 0.05).

Conclusion: Early AS develops in more than one third of SLE patients. Main risk factors of early AS are conventional ones and APL antibodies, persistence of chronic inflammation, decreased glomerular filtration rate, prednisolone therapy. LN influence on the process of atherogenesis in SLE may be mediated and caused by high rate of other risk factors.