Premature coronary artery disease and early stage chronic kidney disease

Area of Science:

• Nephrology
• Cardiology
• Radiology

Background:

• Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease (CVD).
• Cardiovascular risk increases notably as estimated glomerular filtration rate (eGFR) declines, particularly below 75ml/min/1.73m2.
• The underlying pathophysiology of CVD in CKD is complex and still under investigation.

Observation:

• A 30-year-old male with stage 3 CKD due to Focal Segmental Glomerulosclerosis presented asymptomatically.
• Cardiac magnetic resonance imaging revealed left ventricular hypertrophy (LVH) and sub-endocardial scarring, indicative of CKD-associated cardiomyopathy.
• CT coronary calcium scoring was elevated, and CT coronary angiogram showed non-flow limiting coronary artery disease (CAD).

Findings:

• Early-stage CKD contributes to myocardial hypertrophy and fibrosis.
• CKD accelerates the development of coronary artery atheroma.
• The patient exhibited multiple cardiovascular complications despite being asymptomatic.

Implications:

• This case underscores the critical link between early CKD and accelerated cardiovascular risk.
• Prompt cardiovascular risk assessment and management are crucial for CKD patients.
• Current treatment strategies focus on blood pressure control and statins, though further research into CKD-specific CVD pathophysiology is needed.