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Renal Behçet's disease: a cumulative analysis
Tekin Akpolat1, Mustafa Akkoyunlu, Ilkser Akpolat
1Ondokuz Mayis University School of Medicine, Samsun-Turkey. ilksertekin@superonline.com
Insights
Renal involvement in Behçet
Area of Science:
- Nephrology
- Rheumatology
- Internal Medicine
Background:
- Behçet's disease (BD) is a multisystemic inflammatory disorder.
- Renal involvement is a recognized but often underreported complication of BD.
Observation:
- This study analyzed cumulated data on 159 patients with BD and renal disease.
- Key renal manifestations included amyloidosis, glomerulonephritis (GN), and renal vascular disease.
- Male gender was identified as a risk factor for renal complications in BD.
Findings:
- Amyloidosis, particularly AA-type, was frequently associated with nephrotic syndrome and renal failure.
- Glomerulonephritis presented a spectrum from asymptomatic proteinuria to rapidly progressive GN, with crescentic GN being common.
- Renal vascular disease, including aneurysms and thrombosis, often co-occurred with other renal pathologies and hypertension.
Implications:
- Renal involvement in BD may be more prevalent than previously thought, though often mild.
- Amyloidosis is a significant prognostic factor, and vascular involvement increases this risk.
- Colchicine may benefit patients with vascular involvement; hemodialysis and transplantation are viable for uremia.
Objective:
To analyze cumulated data about renal involvement in Behçet's disease (BD) and to report on 6 patients with BD and renal problems.
Methods:
We found reports of 159 patients (including our patients) with BD and specific renal disease (amyloidosis 69, glomerulonephritis [GN] 51, renal vascular disease 35, and interstitial nephritis 4) in our survey.
Results:
The frequency of renal problems among BD patients has been reported to vary between 0% to 55%. Male gender is a risk factor for all types of renal BD. Nephrotic syndrome was present in 83% of patients with amyloidosis, and renal failure was common at the time of diagnosis. The mean interval between the initial manifestation of BD and diagnosis of amyloidosis was shorter in men than in women (P =.02). AA-type amyloid fibrils were shown in all cases studied. Vascular involvement was common in the patients with amyloidosis (60%). The renal findings in GN show a wide spectrum, from asymptomatic hematuria and/or proteinuria to rapidly progressive GN. Several types of glomerular lesions ranging from minor glomerular changes to crescentic glomerulonephritis are observed in BD. The common types of glomerular lesions among the reported cases are crescentic GN, proliferative GN, and immunoglobulin A (IgA) nephritis. Aneurysms may be located throughout the renal artery, from the orifice of the main artery to intrarenal microaneurysms. Another type of renal disease (amyloidosis or GN) and other major vascular involvement were present in all cases with renal vein thrombosis. Hypertension is common among patients with renal artery aneurysm or stenosis. Microscopic vascular disease was described in 4 patients.
Conclusions:
Based on data in the literature, we suggest that renal involvement in BD is more frequent than has been recognized, although it is most often mild in nature. Amyloidosis is one of the prognostic factors affecting survival. Patients with vascular involvement carry high risk for amyloidosis, and administration of colchicine to these patients may be beneficial. More evidence is needed to accept interstitial nephritis as a manifestation of BD. In spite of some difficulties, hemodialysis and renal transplantation are safe treatment options in BD-related uremia.