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[The clinical characteristics of Takayasu's arteritis with glomerulonephropathy]
1Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China.
Insights
Takayasu
Area of Science:
- Nephrology
- Rheumatology
- Internal Medicine
Background:
- Takayasu's arteritis (TAK) is a rare, chronic inflammatory disease affecting large arteries.
- Glomerulonephritis is an uncommon but serious complication of TAK.
- Understanding the clinical profile of TAK with glomerulonephropathy is crucial for effective management.
Purpose of the Study:
- To investigate the clinical features of Takayasu's arteritis (TAK) associated with glomerulonephropathy.
- To enhance physician awareness regarding this specific complication in TAK patients.
Main Methods:
- Retrospective analysis of clinical data from 8 patients diagnosed with TAK and glomerulonephropathy.
- Data collected included clinical manifestations, laboratory tests, imaging findings, and treatment outcomes.
- Renal biopsy confirmed glomerulonephropathy in all patients.
Main Results:
- The study identified 6 women and 2 men with a median onset age of 24 years.
- Common findings included hypertension (5 patients) and significant proteinuria (0.18-14.91 g/24h).
- Mesangial proliferative glomerulonephritis was the most frequent biopsy finding (3 patients).
Conclusions:
- Glomerulonephropathy occurs occasionally in patients with Takayasu's arteritis.
- Mesangial proliferative glomerulonephritis is the predominant pathological subtype.
- Combination therapy with glucocorticoids and cyclophosphamide may be a viable treatment option.
Abstract:
Objective: To investigate the clinical features of Takayasu's arteritis (TAK) with glomerulonephropathy and to improve physicians' understanding of this complication in patients with TAK. Methods: Clinical data were retrospectively collected including manifestations, laboratory tests, image findings and treatment of 8 patients diagnosed as Takayasu's arteritis with glomerulonephropathy from January 2002 to January 2017 in Peking Union Medical College Hospital. Results: Glomerulonephropathy was confirmed based on percutaneous renal biopsy. There were 6 women and 2 men. The median onset age and median disease duration were 24 (18-37) years and 42 (3-360) months, respectively. Five patients had hypertension. The 24 hour urinary protein was 0.18-14.91 g. Red blood cells and casts in urine were tested among 4 and 2 patients, respectively. Three patients had renal artery stenosis. Three patients demonstrated mesangial proliferative glomerulonephritis, two with IgA nephropathy, two with minimal change disease and one with membranoproliferative glomerulonephritis. Seven patients received glucocorticoid combined with cyclophosphamide therapy (glucocorticoid 40-60 mg/d, prednisone or equivalent; cyclophosphamide 0.4 g/week iv. or cyclophosphamide 0.1 g/d po.). Uninary blood cells removed and 24 hour urinary protein decreased from 1.65 g to 0.90 g after treatment for 12 months in one patient. The other 7 patients were missing. Conclusion: Glomerulonephropathy is occasionally observed among TAK patients. Mesangial proliferative glomerulonephritis is the most common pathological subtype. Glucocorticoid combined with cyclophosphamide therapy could be an optional therapy for Takayasu's arteritis with glomerulonephropathy.