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[Beware, polyarteritis nodosa still exists in nephrology!]
Justine Perrin1, Julien Carvelli1, Bertrand Gondouin1
1Centre de néphrologie et transplantation rénale, faculté de médecine, Aix-Marseille université, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France.
Nephrologie & Therapeutique
|October 1, 2016
Summary
Polyarteritis nodosa, a rare vasculitis, can cause acute kidney injury and malignant hypertension. Diagnosis requires angiography to detect microaneurysms, as renal biopsy carries a high risk of hemorrhage.
Area of Science:
- Nephrology
- Rheumatology
- Vascular Medicine
Background:
- Systemic vasculitides affecting the kidneys are medical emergencies.
- Polyarteritis nodosa (PAN) is a rare but important consideration in renal vasculitis.
- Early diagnosis and appropriate management are crucial for patient outcomes.
Observation:
- A 70-year-old presented with acute renal failure, malignant hypertension, and albuminuria.
- Subcutaneous nodules, orchitis, and mononeuritis developed subsequently.
- Initial workup for autoimmunity and viral infections was negative; thrombotic microangiopathy markers resolved with blood pressure control.
Findings:
- Renal computed tomography was normal, but renal biopsy revealed vascular lesions and glomerular ischemia.
- The patient experienced hemorrhagic shock post-biopsy.
- Arterial angiography ultimately diagnosed polyarteritis nodosa by revealing renal microaneurysms.
Implications:
- Polyarteritis nodosa should be considered in patients with renal involvement, malignant hypertension, and specific clinical signs, even with albuminuria.
- Arterial angiography is recommended for detecting microaneurysms, while renal biopsy is contraindicated due to high hemorrhage risk.
- PAN diagnosis is possible even without hepatitis B infection, highlighting the need for vigilance in nephrology.
Keywords:
Acute renal failureAneurysm polyarteritis nodosaAnévrysmeInsuffisance rénale aiguëPériartérite noueuseSystemic vasculitisVascularite systémiqueMore Related Videos
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