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Reversible bilateral hydronephrosis without obstruction in hepatitis B-associated polyarteritis nodosa
L F Casserly1, S M Reddy, H G Rennke
1Evans Memorial Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA. lfc@bu.edu
Summary
This study details a rare case of hepatitis B-associated polyarteritis nodosa (PAN) presenting with bilateral hydronephrosis without obstruction. Prompt treatment led to resolution of kidney swelling and recovery of renal function.
Area of Science:
- Nephrology
- Rheumatology
- Urology
Background:
- Polyarteritis nodosa (PAN) is a systemic vasculitis with diverse clinical manifestations.
- Urological involvement in PAN typically includes ureteric stenosis and orchitis.
- Hepatitis B infection is a known cause of secondary PAN.
Observation:
- A case of hepatitis B-associated PAN presented with bilateral hydronephrosis.
- Retrograde urography confirmed the absence of urinary tract obstruction.
- The likely etiology was vasculitis affecting ureteral nerves or muscles.
Findings:
- Treatment with steroids, cyclophosphamide, and plasmapheresis resolved the hydronephrosis.
- The patient recovered sufficient renal function to discontinue dialysis.
- Literature review highlights diagnostic challenges and treatment strategies for hepatitis B-associated PAN.
Implications:
- This case expands the known urological manifestations of PAN.
- Early diagnosis and aggressive treatment are crucial for renal recovery in PAN.
- Understanding vasculitis-related neuropathy/myopathy is key to managing non-obstructive hydronephrosis in PAN.