Renal and cardiopulmonary manifestations in patients with juvenile systemic lupus erythematosus: Clinical experience in Cali, Colombia

Abstract

Introduction

Juvenile systemic lupus erythematosus (jSLE) is a chronic, multisystemic autoimmune disease with a variable course and prognosis. The pediatric population accounts for 20% of total SLE cases. Renal and cardiopulmonary manifestations contribute significantly to morbidity and mortality.

Objective

To clinically and demographically characterize the renal and cardiopulmonary manifestations of jSLE in the study population.

Materials and methods

A cross-sectional observational study was conducted in patients with jSLE (EULAR/ACR-2019 criteria) at a Pediatric Rheumatology clinic in Cali, Colombia, between 2012 and 2024. Data were collected from medical records and analyzed using the IBM SPSS v29 statistical program.

Results

Among 98 patients with JSLE, 30.6% had renal involvement, 10.2% had cardiopulmonary involvement, and 6.1% had both. Regarding renal involvement, 83.3% were female, with a mean age of 11.4 years; 76.6% presented at disease onset, while 13.3% developed renal involvement more than two years after diagnosis. Most patients presented with proteinuria, hypertension, and nephrotic syndrome. Renal biopsy was performed in 73.3% of cases, revealing nephritis types 2, 3, and 4 (ISN/RPS classification) in 13.3%, 10%, and 50% of patients, respectively. The mean activity index was 9/24, and the chronicity index was 2/12. Regarding cardiopulmonary involvement, 90% of patients were female, with a mean age of 12.5 years; 90% presented at diagnosis. The most common clinical manifestations were chest pain, pleuritis, and pericarditis. Laboratory findings in renal involvement included anemia, elevated erythrocyte sedimentation rate (ESR), decreased complement levels (C3 and C4), and positive Anti-DNA and Anti-SM antibodies. In cardiopulmonary involvement, findings included elevated C-reactive protein and ESR, decreased C3 and C4 levels, and positive Anti-DNA, Anti-SM, and Anti-RNP antibodies. Additionally, 40% of patients with renal involvement and 60% of those with cardiopulmonary involvement had other autoimmune diseases. Mortality occurred in one patient with mixed involvement.

Conclusion

In jSLE, renal involvement is a common presentation at disease onset, while cardiopulmonary involvement is less prevalent. Despite the severity of these manifestations, mortality was low. However, the high inflammatory activity and significant percentage of autoimmune comorbidities highlight the complexity of this condition and underscore the importance of early identification and treatment to improve the quality of life of this population.