Renal Vascular Affection in Systemic Sclerosis Patients and Possible Correlation with Peripheral Vascular Involvement Assessed by Nailfold Capillaroscopy

TL;DR

This study explores kidney and blood vessel issues in systemic sclerosis patients using ultrasound and nailfold capillaroscopy.

Contribution

The study identifies early asymptomatic kidney involvement and its correlation with disease severity and vascular changes in systemic sclerosis.

Findings

Elevated renal resistive index (RRI) was found in 44% of patients, indicating potential early kidney issues.

RRI correlated with age, disease severity, and avascular nailfold capillaroscopy scores.

High RRI was predicted by age > 43 years, disease severity score > 5, and low capillary density.

Abstract

Symptomatic renal involvement was observed in only 24% of systemic sclerosis (SSc) patients.

We evaluated renal vascular affection, which is linked to disease characteristics and nailfold capillaroscopy (NFC) outcomes in SSc patients

Fifty SSc individuals were subjected to renal doppler ultrasound, NFC, and evaluation of disease severity utilising the Medsger disease severity scale.

The cohort comprised 46 females and 4 males, with a mean age of 33.82 ± 11.19 years. Symptomatic renal affection [proteinuria, elevated creatinine level, and mitigated creatinine clearance, and estimated glomerular filtration rate (eGFR) ± hypertension] was observed in 24% of subjects. However, an elevated renal resistive index (RRI) was detected in 44%. Accordingly, patients were allocated into Group 1 (patients exhibiting normal RRI, n = 28) and Group 2 (patients manifesting raised RRI, n = 22). Group 2 patients experienced significantly older age, prolonged disease duration, raised severity scores, protein/creatinine ratio, and avascular NFC scores (p < 0.05). The RRI demonstrated a positive association with age, disease duration, severity, duration of Raynaud’s phenomenon, and avascular scores (p < 0.05), alongside negative correlations with creatinine clearance, eGFR, and capillary density (p < 0.05). The main predictors of high RRI encompassed age > 43 years, disease severity score > 5, protein/creatinine ratio > 0.21, capillary density ≤ 6, and avascular score > 1 (p = 0.05).

The RRI detected early asymptomatic renal affection, which correlated positively with age, disease duration, severity, and high NFC avascular scores and negatively with creatinine clearance and eGFR.

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