ABSTRACT
OBJECTIVE: To examine the association between cardiovascular reactivity to a set of psychological stressors and carotid artery intima-media thickness, a marker of subclinical cardiovascular disease in healthy adolescents. METHODS: Participants were 25 boys and 23 girls age 14.2 ± 0.9 years who were measured for heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure reactivity to mirror-tracing, reaction time, speech preparation and ad lib speech tasks and for common carotid artery intima-media thickness. Sequential regression analyses were used to establish the incremental increase in R(2)(R(inc)(2)) for the prediction of intima-media thickness due to cardiovascular reactivity independent of age, BMI percentile, sex, socioeconomic status, and resting HR or BP. RESULTS: SBP reactivity while preparing (ß=0.0019, R(inc)(2)=0.09) and giving the speech (ß=0.0014, R(inc)(2)=0.10) and an aggregate reactivity score based on all 4 tasks (ß=0.0026, R(inc)(2)=0.11) independently predicted (p ≤ 0.05) mean carotid artery intima-media thickness. Neither DBP reactivity nor HR reactivity during any task were independent predictors of intima-media thickness. CONCLUSION: Stress-induced cardiovascular reactivity, and especially SBP reactivity, is associated with carotid intima-media thickness and the early pathogenesis of cardiovascular disease. The use of an aggregate stress reactivity index provides a more reliable reflection of trait SBP reactivity to psychological stress and increases the confidence that youth with greater cardiovascular stress reactivity may indeed have greater progression of subclinical cardiovascular disease.
Subject(s)
Atherosclerosis/pathology , Cardiovascular Diseases/etiology , Cardiovascular System/physiopathology , Stress, Psychological/physiopathology , Adolescent , Blood Pressure/physiology , Carotid Arteries/diagnostic imaging , Carotid Arteries/pathology , Female , Heart Rate , Humans , Male , Tunica Intima/pathology , Tunica Media/pathology , UltrasonographyABSTRACT
Lithium-induced glomerular toxicity is an infrequent occurrence in pediatric patients. We report a 13-year-old patient presenting with clinical and laboratory evidence of renal insufficiency after long-term lithium use. Biopsy revealed membranous glomerulonephropathy. Discontinuation of the lithium treatment resulted in resolution of the symptoms and laboratory abnormalities. Other alkali metals have been implicated as risk factors for membranous glomerulonephropathy. To the best of our knowledge, this is the first reported case of lithium-induced glomerulonephropathy in a pediatric patient.
