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Kidney function and renal resistive index in children with juvenile idiopathic arthritis

Alessandro Cafarotti1, Maria Loredana Marcovecchio2, Giuseppe Lapergola1

  • 1Department of Paediatrics, University "G. d'Annunzio", Chieti, Italy.

Clinical and Experimental Medicine
|September 21, 2022
PubMed

Insights

Juvenile idiopathic arthritis (JIA) patients show reduced kidney function and increased urinary albumin excretion. Renal resistive index (RRI) is higher in JIA children, especially those on biologic drugs, indicating potential disease-related kidney impact.

Area of Science:

  • Pediatric Rheumatology
  • Nephrology
  • Medical Imaging

Background:

  • Juvenile idiopathic arthritis (JIA) is a prevalent pediatric rheumatic condition.
  • Renal manifestations are uncommon in JIA, with amyloidosis being a known complication in systemic JIA (sJIA).
  • Understanding subclinical renal damage and its relationship with JIA treatment is crucial.

Purpose of the Study:

  • To investigate renal damage in children with JIA.
  • To establish the relationship between renal parameters and JIA treatments.
  • To assess markers of kidney function and renal hemodynamics in JIA patients.

Main Methods:

  • Assessed blood urea nitrogen (BUN), creatinine, cystatin C (CysC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urinary albumin excretion (UAE), estimated glomerular filtration rate (eGFR), and renal resistive index (RRI).
  • Compared 49 JIA children (22 on methotrexate [MTX], 27 on biologics) with 49 healthy controls.
  • Analyzed associations between RRI and inflammatory markers, disease activity, and patient characteristics.

Main Results:

  • JIA children exhibited higher CysC and BUN, lower creatinine and eGFR, and increased UAE compared to controls.
  • Mean RRI was significantly higher in JIA patients than in controls (0.7 ± 0.04 vs. 0.6 ± 0.04).
  • Patients on biologic drugs showed higher RRI than those on MTX (0.7 ± 0.1 vs. 0.7 ± 0.04), with RRI correlating with ESR, JADAS-27, disease state, BMI-SDS, CRP, and eGFR.

Conclusions:

  • JIA is associated with reduced kidney function (lower eGFR), increased microalbuminuria (higher UAE), and altered renal hemodynamics (higher RRI).
  • Higher RRI in patients on biologics suggests a potential direct effect of the disease or treatment on renal vasculature.
  • RRI is a sensitive indicator of renal involvement in JIA, linked to inflammation and disease activity.

Keywords:
Cystatin CJuvenile arthritisKidneyRenal damageRenal resistive indexUrinary albumin excretion

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