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Gülle S, Komaç Ö, Can G, Önen F. A rare condition in Takayasu arteritis: Renal amyloidosis. Arch Rheumatol 2023; 38:653-655. [PMID: 38125062 PMCID: PMC10728745 DOI: 10.46497/archrheumatol.2023.9893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/06/2022] [Indexed: 12/23/2023] Open
Affiliation(s)
- Semih Gülle
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Ömer Komaç
- Department of Internal Medicine, Kocaeli State Hospital, Kocaeli, Türkiye
| | - Gerçek Can
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Fatoş Önen
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
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2
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Boubaker K, Kaaroud H, Goucha R, Kheder A. [Renal injury in Takayasu's arteritis]. Nephrol Ther 2014; 10:451-6. [PMID: 25440941 DOI: 10.1016/j.nephro.2014.07.483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/04/2014] [Accepted: 07/04/2014] [Indexed: 11/24/2022]
Abstract
Renal involvement in Takayasu's arteritis is frequent and worsens the progression of the disease. This is primarily a renal artery stenosis causing renovascular hypertension. The glomerular disease is exceptional. This study was undertaken to determine the clinical, radiological, biological features and therapeutic response in patients with kidney disease associated with Takayasu arteritis. A retrospective chart review was conducted on 11 patients (five men and six females), with a mean age of 31.1 years (19-40 years). The discovery of kidney disease preceded the diagnosis of Takayasu's arteritis in eight cases. Ten patients developed hypertension. Laboratory finding showed proteinuria in five cases of which one case was due to nephrotic syndrome. Renal failure was found in six cases including four cases in stage of terminal chronic renal failure. Impairment of the renal artery was present in nine patients, proximal in seven cases and distal in two cases, bilateral in five cases and unilateral in four cases. Narrowing renal artery was found in seven cases. The renal biopsy revealed membranoproliferative glomerulonephritis in one case and nephrosclerosis in another case. Eleven patients were followed for an average period of 155 months (3-335 months). Remission of nephrotic syndrome was concomitant with the remission of the disease. Seven patients developed outbreaks of Takayasu's arteritis of which six were in care. Relapse of nephrotic syndrome was concomitant with the outbreak of the disease followed by spontaneous remission of both diseases. Improved pressure was obtained in 5 cases and worsening renal function in seven cases. Death was observed in two cases.
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Affiliation(s)
- Karima Boubaker
- Service de médecine interne A (M8), hôpital Charles-Nicolle, boulevard du 9 avril, 1006 Bab, Souika, Tunis, Tunisie.
| | - Hayet Kaaroud
- Service de médecine interne A (M8), hôpital Charles-Nicolle, boulevard du 9 avril, 1006 Bab, Souika, Tunis, Tunisie
| | - Rim Goucha
- Service de médecine interne A (M8), hôpital Charles-Nicolle, boulevard du 9 avril, 1006 Bab, Souika, Tunis, Tunisie
| | - Adel Kheder
- Service de médecine interne A (M8), hôpital Charles-Nicolle, boulevard du 9 avril, 1006 Bab, Souika, Tunis, Tunisie
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Koda R, Yoshino A, Imanishi Y, Kawamoto S, Ueda Y, Kazama JJ, Narita I, Takeda T. A Case of Membranous Glomerulonephropathy Associated with Takayasu's Arteritis. Case Rep Nephrol Dial 2014; 4:60-9. [PMID: 24847348 PMCID: PMC4025153 DOI: 10.1159/000360850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Glomerulonephropathy is a rare complication of Takayasu's arteritis (TA). To date, most glomerulonephropathies associated with TA show the histological feature of mesangial proliferation. Membranous glomerulonephropathy (MG) is a form of glomerulonephropathy in which the mesangial proliferation is not conspicuous and its association with TA is extremely rare. A 54-year-old man was referred to our hospital due to progressive edema in the lower limbs and nephrotic range proteinuria. Five years previously, he underwent percutaneous angioplasty for left subclavian artery stenosis. Kidney biopsy revealed stage II MG. General examination including enhanced CT scan confirmed the presence of TA. He started oral prednisolone therapy at a dose of 40 mg daily. The C-reactive protein level normalized 7 days after the prednisolone therapy. Three months later, proteinuria had remitted. Though the true relationship between MG and TA was not revealed in present case, considering the fact that complete remission of nephrotic syndrome occurred following the improvement of C-reactive protein level in response to steroid therapy, TA might be the secondary cause of MG. To our best knowledge, only two case reports described the association of MG and TA previously. Those two patients, however, also demonstrated the feature of systemic lupus erythematosus in addition to TA. This is the first case report that describes a patient who presented as MG associated with TA, but not complicated by systemic lupus erythematosus.
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Affiliation(s)
- Ryo Koda
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Atsunori Yoshino
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Yuji Imanishi
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Shinya Kawamoto
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Junichiro James Kazama
- Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tetsuro Takeda
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
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4
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Familial Takayasu arteritis in a mother and daughter: a report of two cases. Herz 2013; 38:93-6. [DOI: 10.1007/s00059-012-3653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 06/20/2012] [Accepted: 06/23/2012] [Indexed: 11/29/2022]
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5
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Havill JP, Levine SM, Kuperman M, Hellmann DB, Geetha D. Falling through the cracks of vasculitis classification-a report of three patients. NDT Plus 2011; 4:327-30. [PMID: 25984180 PMCID: PMC4421729 DOI: 10.1093/ndtplus/sfr054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 03/16/2011] [Indexed: 12/02/2022] Open
Affiliation(s)
- John P Havill
- Division of Nephrology, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Stuart M Levine
- Division of Rheumatology, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Michael Kuperman
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - David B Hellmann
- Division of Rheumatology, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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6
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Baker-LePain JC, Farmer-Boatwright MK, Dooley MA. Concurrent Takayasu's arteritis and antineutrophil cytoplasmic antibody-related glomerulonephritis related to use of propylthiouracil. J Rheumatol 2009; 36:1552-4. [PMID: 19567638 DOI: 10.3899/jrheum.081177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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7
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Li XM, Ye WL, Wen YB, Li H, Chen LM, Liu DY, Zeng XJ, Li XW. Glomerular Disease Associated with Takayasu Arteritis: 6 Cases Analysis and Review of the Literature. ACTA ACUST UNITED AC 2009; 24:69-75. [DOI: 10.1016/s1001-9294(09)60063-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Crescentic glomerulonephritis are characterised by a crescent shaped cellular proliferation that may lead to glomerular destruction. Over 50% of at least 10 analysed glomeruli should be affected. The search for immune deposits by immunofluorescence is an important diagnostic step. Patients present with rapidly progressive glomerulonephritis (RPGN): renal failure, proteinuria and haematuria. Extra-renal symptoms may help diagnosis. Diseases are classified in three groups according to immunofluorescence studies. Group I is characterised by linear deposits along the glomerular basement membrane (GBM) with anti-GBM auto-antibodies responsible for Goodpasture's disease. Group II put together various diseases with immune complex deposits. In group III, no significant immune deposits are found. Those "pauci-immune" glomerulonephritis are secondary to anti-neutrophil cytoplasmic antibodies (ANCA) positive systemic vasculitis, mainly Wegener's granulomatosis and microscopic polyangiitis. Primary glomerulonephritis may also be associated with crescent formation. Treatment is urgently required. Diagnosis is suspected in the context of extra-renal symptoms or immunological abnormalities, and confirmed by a kidney biopsy, that also helps to define prognosis. Apart from some group II glomerulonephritis, the induction treatment is often an association of steroids and cyclophosphamide, with plasma exchange in case of Goodpasture's disease. After remission, a maintenance treatment is required for ANCA-positive vasculitis to prevent relapses. The high rate of opportunistic infections and cancer give the rational for searching less aggressive therapeutic options.
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Affiliation(s)
- Vincent Louis-Marie Esnault
- Service de Néphrologie-Immunologie Clinique, Hotel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
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Kuroda T, Ueno M, Sato H, Murakami S, Sakatsume M, Nishi S, Nakano M, Gejyo F. A case of Takayasu arteritis complicated with glomerulonephropathy mimicking membranoproliferative glomerulonephritis: a case report and review of the literature. Rheumatol Int 2006; 27:103-7. [PMID: 16830159 DOI: 10.1007/s00296-006-0156-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2005] [Accepted: 06/08/2006] [Indexed: 10/24/2022]
Abstract
In this report, we describe the case of a 50-year-old Japanese woman with Takayasu arteritis who developed severe proteinuria and renal dysfunction. Abdominal computed tomography did not show narrowing of both renal arteries. Although her levels of C-reactive protein were negative, plasma vascular endothelial growth factor (VEGF) and serum interleukin (IL)-6 levels were elevated. Renal biopsy showed glomerulonephropathy mimicking membranoproliferative glomerulonephritis (MPGN) with glomerular capillary wall thickening (double contour). This was accompanied by mesangial cell proliferation and moderate increase of mesangial matrix without deposits of C3. These findings are quite different from MPGN as electron microscopy did not show subendothelial deposit and circumferential mesangial interposition. Here, we present the case of Takayasu arteritis associated with MPGN-like renal manifestation and elevated VEGF and IL-6. The presence of elevated VEGF and IL-6 could be factors that might contribute to MPGN-like appearance.
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Affiliation(s)
- Takeshi Kuroda
- Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata City, 951-8510, Japan.
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Tiryaki O, Buyukhatipoglu H, Onat AM, Kervancioglu S, Cologlu S, Usalan C. Takayasu arteritis: association with focal segmental glomerulosclerosis. Clin Rheumatol 2006; 26:609-11. [PMID: 16496079 DOI: 10.1007/s10067-005-0190-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
Abstract
We herein report on a 29-year-old woman who presented with edema and proteinuria. In light of her blood pressure differences and, finally, with the angiographic findings, Takayasu arteritis (TA) was the diagnosis. Renal biopsy showed focal segmental glomerulosclerosis (FSGS) and other possible etiologic alternatives were excluded. This was a very rare association and we could not find any other cases reported on TA accompanied with FSGS before. A poor treatment response was observed at the end of a 1-year therapy.
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Affiliation(s)
- Ozlem Tiryaki
- Department of Internal Medicine, Gaziantep University Medical School, Gaziantep, Turkey
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11
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Kuroda T, Ohbayashi H, Murakami S, Ito S, Sakatsume M, Ueno M, Nishi S, Nakano M, Gejyo F. A case of Takayasu arteritis complicated with glomerulonephropathy mimicking membranoproliferative glomerulonephritis. Clin Rheumatol 2005; 23:536-40. [PMID: 15801074 DOI: 10.1007/s10067-004-0936-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report on a 65-year-old Japanese woman with Takayasu arteritis who developed severe proteinuria, hypertension, and renal dysfunction. Renal angiography demonstrated moderate irregular narrowing of both renal arteries. Renal biopsy showed glomerulonephropathy mimicking membranoproliferative glomerulonephritis (MPGN) with glomerular capillary wall thickening ("double contour") accompanied by mesangial cell proliferation and moderate increase of mesangial matrix without deposits of C3. Electron microscopy showed no subendothelial deposit and no circumferential mesangial interposition (CMI), and these findings are different from MPGN. In this report we present a case of Takayasu arteritis associated with glomerulonephropathy mimicking MPGN.
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Affiliation(s)
- Takeshi Kuroda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, 951-8510 Niigata City, Japan.
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12
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Chaubal N, Dighe M, Shah M. Sonographic and color doppler findings in aortoarteritis (Takayasu arteritis). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:937-944. [PMID: 15292562 DOI: 10.7863/jum.2004.23.7.937] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To review the sonographic appearance of aortoarteritis. METHODS A pictorial review of cases is presented. RESULTS Sonography in conjunction with color and pulsed Doppler imaging is a valuable tool in the evaluation of aortoarteritis. We can accurately diagnose, grade, and follow the progress of the disease. The response to treatment can also be assessed. This presentation reviews the sonographic findings in aortoarteritis. CONCLUSIONS Color-coded Doppler sonography can facilitate an accurate diagnosis of Takayasu arteritis by the characteristic appearance. Associated organ involvement can also be assessed.
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Abstract
Takayasu arteritis is an uncommon disease with a variety of presentations. We report a case of Takayasu arteritis with a presentation of a pulmonary-renal syndrome in a 22-year-old woman. She presented in acute respiratory failure with hemoptysis and acute renal failure; interestingly, however, the renal biopsy was normal. Magnetic resonance angiography (MRA) showed significant narrowing in the distal abdominal aorta with bilateral renal and common iliac artery occlusions. Thoracic and abdominal angiogram confirmed MRA findings of type IV Takayasu arteritis. Percutaneous transluminal angioplasty of the left renal artery normalized kidney function. The initial presentation of Takayasu arteritis as a pulmonary-renal syndrome with severe acute renal failure and diffuse pulmonary hemorrhage is unusual; to our knowledge, this has not been described previously in the literature. We provide a clinical review of Takayasu arteritis and a discussion of systemic manifestations pertinent to the case.
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Affiliation(s)
- Brian J Savage
- Department of Medicine, University of Virginia, Charlottesville, USA
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Wada Y, Nishida H, Kohno K, Tamai O, Fujisawa M, Katoh S, Morimatsu M, Okuda S. AA amyloidosis in Takayasu's arteritis--long-term survival on maintenance haemodialysis. Nephrol Dial Transplant 1999; 14:2478-81. [PMID: 10528678 DOI: 10.1093/ndt/14.10.2478] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Wada
- Department of Internal Medicine III, Kurume University School of Medicine, Fukuoka, Japan
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15
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Arita M, Iwane M, Nakamura Y, Nishio I. Anticoagulants in Takayasu's arteritis associated with crescentic glomerulonephritis and nephrotic syndrome: a case report. Angiology 1998; 49:75-8. [PMID: 9456168 DOI: 10.1177/000331979804900110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors describe a 46-year-old Japanese woman who had Takayasu's arteritis associated with nephrotic syndrome due to mesangial proliferative glomerulonephritis with crescent. Although a few cases of focal and segmental mesangial proliferative glomerulonephritis associated with Takayasu's arteritis have been reported, nephrotic syndrome has not been reported previously in this situation.
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Affiliation(s)
- M Arita
- Division of Cardiology, Department of Medicine, Wakayama Medical College, Japan
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Abstract
Takayasu arteritis (TA) is a chronic inflammatory and obliterative disease of large vessels particularly the aorta and its major branches. Recently, the disease has been shown to involve the parenchyma of various organs. Specific glomerular lesions reported in patients with TA are mesangial proliferative, membrano-proliferative, crescentic glomerulonephritis and amyloidosis. Dermatological manifestations of this disease are erythema nodosum, facial lupus rash and erythema induratum. Dilated cardiomyopathy, myocarditis and pericarditis have been reported in TA. Rarely, interstitial lung disease, pneumonic consolidation, idiopathic ulcerative colitis, rheumatoid arthritis and polymyositis have been described in association with TA. In this report, five patients of TA with primary parenchymatous involvement of kidneys, skin, heart and gastrointestinal tract have been described. An association of primary parenchymatous organ involvement and TA suggests an autosensitization to an unidentified antigen in the pathogenesis of TA.
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Affiliation(s)
- B K Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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18
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Abstract
Systemic vasculitic syndromes are rare in childhood. Vasculitis is the predominant feature of a large number of different clinical entities that are linked by the presence of inflammatory changes in the blood vessels. The nature of these diseases and their relationship to each other remain unclear. The clinical presentation associated with the size of the affected vessels and epidemiological data are very helpful for the diagnosis of those diseases. Recent advances are beginning to shed some light on the etiology and pathogenetic mechanisms involved in the various vasculitides. There is good evidence to support roles for circulating immune complexes, cell-mediated immunity, anti-neutrophil cytoplasmic antibodies and anti-endothelial cell antibodies in the pathogenesis. Renal involvement in vasculitis in children is commonly seen in Henoch-Schönlein purpura, microscopic polyarteritis, Wegener's granulomatosis, Churg-Strauss syndrome and polyarteritis nodosa. However, kidney disease can also be part of the clinical picture of Kawasaki disease and Takayasu arteritis. Recently, with the institution of early and aggressive immunosuppressive treatment of severe cases, significant improvement in the long-term survival of patients has been achieved. This review article addresses the pathological and clinical features (particularly renal involvement), therapeutic intervention and prognosis of the above-mentioned diseases.
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Affiliation(s)
- I Roberti
- Division of Pediatric Nephrology, Mount Sinai Medical Center, New York
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Hong CY, Yun YS, Choi JY, Sul JH, Lee KS, Cha SH, Hong YM, Lee HJ, Hong YJ, Sohn KC. Takayasu arteritis in Korean children: Clinical report of seventy cases. Heart Vessels 1992; 7:91-6. [PMID: 1360979 DOI: 10.1007/bf01744551] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Seventy cases of Takayasu arteritis in Korean children are reported. There were 57 females and 13 males (male-to-female ratio; 1:4.4). The youngest patient was a 3-year-old female. Family history was positive in one patient. The most common chief complaints on admission were dyspnea, headache, palpitation, and edema which were due to hypertension and congestive heart failure. Hypertension was seen in 65 out of 70 patients (92.8%). The abdominal aorta, thoracic aorta, and renal arteries were the most commonly involved sites in these children. Two patients had nephrotic syndrome. The frequency of positive tuberculin reaction was much higher in children with Takayasu arteritis compared with the general population, and the intensity of the reaction was also stronger. The majority of the patients required immediate medical treatment to control congestive heart failure due to hypertension at initial presentation. When ESR was elevated, corticosteroid was administered. Surgical treatment showed good results in six out of ten cases. Percutaneous intraluminal angioplasty was effective for lowering the blood pressure in six out of nine cases. In three cases, restenosis occurred and angioplasty was repeated in two cases.
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Affiliation(s)
- C Y Hong
- Department of Pediatrics, Seoul National University, Korea
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