gms | German Medical Science

Objectives: Premature atherosclerosis is a frequent finding in connective tissue diseases (CTD). In the present study we investigated patients with connective tissue diseases (systemic lupus erythematosus (SLE), scleroderma (PSS), primary antiphospholipid-syndrome (PAPS), primary Sjogrens's syndrome (SS)) for renal artery stenosis (RAS) and atherosclerosis by Doppler sonography.

Methods: 101 patients with CTD (SLE: n=54; PSS: n=39; PAPS: n=4; SS: n=4; 79 women and 22 men) were enrolled. 52 patients (50%) had hypertension (mean age 60 years)(group I), 49 patients were normotensive (mean age 46 years) (group II). Doppler sonography of the carotid and renal arteries was performed using an Acuson Sequoia duplex scanner. Intima-media thickness (IMT) and carotid plaques were measured. Intrarenal restance index was measured in segmental and interlobar arteries. RAS was defined by the detection of a renal artery peak systolic velocity > 180 cm/second.

Results: Thickened IM and carotid plaques were found in 37 (37%) and 48 out of 101 patients (48%), respectively, with a higher prevalence in group I (n=25; 48% and n=33; 63%) compared to group II (n=12; 24% and n=15; 31%). RAS was detected in 6 out of 52 hypertensive patients (11.5%, two patients with SLE and four patients with PSS, mean age 71 years) and none of the normotensive patients. RAS was bilateral in two patients. Three patients underwend angioplasty and stenting. Intrarenal RI were higher in normotensive PSS patients compared to normotensive SLE patients.

Conclusions: Our study confirms the previously reported high prevalence of atherosclerosis in hypertensive and normotensive patients with SLE and PSS. Hypertension may be caused by RAS especially in elderly patients with SLE and PSS (11.5%). The elevated doppler indices of renal vascular resistance in normotensive patients with PSS suggest an altered renal perfusion in absence of obvious renal involvement.