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Peremans L, Twilt M, Benseler SM, Grisaru S, Kirton A, Myers KA, Hamiwka L. Real-World Biomarkers for Pediatric Takayasu Arteritis. Int J Mol Sci 2024; 25:7345. [PMID: 39000452 PMCID: PMC11242898 DOI: 10.3390/ijms25137345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
Childhood-onset Takayasu arteritis (TA) is a rare, heterogeneous disease with limited diagnostic markers. Our objective was to identify and classify all candidates for biomarkers of TA diagnosis in children reported in the literature. A systematic literature review (PRISMA) of MEDLINE, EMBASE, Wiley Cochrane Library, ClinicalTrias.gov, and WHO ICTRP for articles related to TA in the pediatric age group between January 2000 and August 2023 was performed. Data on demographics, clinical features, laboratory measurements, diagnostic imaging, and genetic analysis were extracted. We identified 2026 potential articles, of which 52 studies (81% case series) met inclusion criteria. A total of 1067 TA patients were included with a peak onset between 10 and 15 years. Childhood-onset TA predominantly presented with cardiovascular, constitutional, and neurological symptoms. Laboratory parameters exhibited a low sensitivity and specificity. Imaging predominantly revealed involvement of the abdominal aorta and renal arteries, with magnetic resonance angiography (MRA) being the preferred imaging modality. Our review confirms the heterogeneous presentation of childhood-onset TA, posing significant challenges to recognition and timely diagnosis. Collaborative, multinational efforts are essential to better understand the natural course of childhood-onset TA and to identify accurate biomarkers to enhance diagnosis and disease management, ultimately improving patient outcomes.
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Affiliation(s)
- Lieselot Peremans
- Section of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marinka Twilt
- Section of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Susanne M Benseler
- Section of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Children's Health Ireland, D01 R5P3 Dublin, Ireland
| | - Silviu Grisaru
- Section of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Adam Kirton
- Section of Neurology, Departments of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kimberly A Myers
- Section of Cardiology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Lorraine Hamiwka
- Section of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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Millan P, Gavcovich TB, Abitbol C. Childhood-onset Takayasu arteritis. Curr Opin Pediatr 2022; 34:223-228. [PMID: 35142753 DOI: 10.1097/mop.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Takayasu arteritis is a rare chronic granulomatous large vessel vasculitis that predominantly affects the aorta and its branches. The purpose of this review is to unite the current knowledge regarding the pathophysiology, cause, and epidemiology as well as diagnosis, prognosis, and treatment of this condition in children. RECENT FINDINGS Although the etiopathogenesis is not fully understood, studies suggest an autoimmune basis for the disease as well as a genetic predisposition. It is a disease primarily affecting young women with up to a third of cases with onset in childhood. There are distinct features of childhood-onset Takayasu arteritis (cTA) that merit this separate review. Diagnostic criteria and clinical manifestations are unique in pediatric patients with renovascular hypertension being the most prevalent presentation. Traditional treatments involving high-dose corticosteroids and cytotoxic agents are being reconsidered for less toxic contemporary biologic agents. Current algorithms for treatment include early introduction of corticosteroid-sparing agents, such as methotrexate or mycophenolate as well as tumor necrosis factor-alpha (TNF-α) inhibitor (infliximab, adalimumab) and/or interleukin-6 (IL-6) receptor inhibitor (tocilizumab). SUMMARY Early diagnosis of cTA with goals to develop effective and well tolerated treatment paradigms are essential to improve the long-term prognosis of this rare and devastating disease.
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Affiliation(s)
- Pamela Millan
- Division of Pediatric Nephrology, Department of Pediatrics, University of Miami/Holtz Children's Hospital. Miami, Florida, USA
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Sener S, Basaran O, Ozen S. Wind of Change in the Treatment of Childhood-Onset Takayasu Arteritis: a Systematic Review. Curr Rheumatol Rep 2021; 23:68. [PMID: 34218346 DOI: 10.1007/s11926-021-01032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW We lack evidence-based data for the treatment of childhood-onset Takayasu arteritis (c-TA) since it is a rare disease in children. In this systematic literature review, we aimed to evaluate the treatment choices in c-TA patients and integrate our experience for the treatment of our patients in the recent years/in the biologic era. RECENT FINDINGS We reviewed 24 articles addressing treatments of 413 c-TA patients. Steroids were given to 352 patients (85.2%) as the main immunosuppressive therapy. Other immunosuppressive agents included methotrexate (37.3%), cyclophosphamide (24.5%), azathioprine (16.9%), and mycophenolate mofetil (7.9%). Besides, various biological agents were used, including tumor necrosis factor-alpha inhibitors in 70 of 107 c-TA patients (65.4%) and interleukin-6 inhibitors in 33 of them (30.8%). Biologics are increasingly used in our center as well. Even in severe patients, CYC is switched to either anti-TNF or antiIL6 once disease control is achieved. Recently, in addition to conventional immunosuppressants, biologics are increasingly used in c-TA. We have revised our treatment protocol to start with 1-3 doses of high-dose steroids and CYC, in a child with TA with types III-V involvement and high acute phase reactants; once clinical features subside and CRP normalizes, biologics should be started to replace CYC while decreasing the steroid dose.
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Affiliation(s)
- Seher Sener
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Ozge Basaran
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
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Biologics for childhood systemic vasculitis. Pediatr Nephrol 2019; 34:2295-2309. [PMID: 30203375 DOI: 10.1007/s00467-018-4076-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 12/18/2022]
Abstract
Recent advances have allowed better understanding of vasculitis pathogenesis and led to more targeted therapies. Two pivotal randomized controlled trials, RITUXVAS and rituximab in ANCA-associated vasculitis (RAVE), provide high-quality evidence demonstrating rituximab (RTX) is efficacious in inducing remission in adult ANCA-associated vasculitis (AAV) patients compared with cyclophosphamide (CYC). RAVE also demonstrated superiority of RTX to oral CYC for induction of remission in relapsing disease. Disappointingly, the RTX regimen was not associated with reduction in early serious adverse events. At least nine randomized trials are in progress, aiming to further delineate optimal dosing and duration of RTX therapy in AAV. In particular, the 6-month interim results of the PEPRS trial provide encouraging data specific to children. Due to special concerns related to growth, preservation of fertility, and potential for high cumulative medication doses, children with AAV should be considered as candidates for RTX even as a first-line remission induction therapy. Two randomized clinical trials have defined the role of infliximab in Kawasaki disease (KD), which appears to be as an alternative to a second infusion of intravenous immunoglobulin (IVIG) for treatment-resistant disease. Support for other biologics in the treatment of AAV or for biologics in the treatment of other vasculidities is largely lacking due to either unimpressive trial results or lack of trials. Except for the KD trials and the PEPRS, trials enrolling children remain scant. This review touches on the key trials and case series with biologics in the treatment of vasculitis that have influenced practice and shaped current thinking.
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Pavić R, Blažeković R, Divković D, Marjanović K, Sipl M. Aggressive progression of Takayasu's arteritis in infancy: a case report. Acta Clin Croat 2019; 58:535-539. [PMID: 31969768 PMCID: PMC6971795 DOI: 10.20471/acc.2019.58.03.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Takayasu’s arteritis (TA) affects the aorta and its branches. Immunosuppressants are the usual course of therapy, while surgery has been used in acute cases. There is only scant information on TA in infancy, and the nonspecific symptoms in the initial stage of the disease make the diagnosis difficult and delayed, thus increasing the mortality rate. We describe a case of aggressive progression of TA in an infant. This child was the youngest to be affected with the disease as reported in the literature. A 3.5-month-old boy presented with cyanosis of both legs, tachycardia and antithrombin III deficiency. Computed tomography angiography (CTA) revealed thrombosis of distal aorta and both iliac arteries. Thrombectomy was performed at the level of both common femoral arteries. In addition, thigh amputation of the left leg had to be performed. TA was diagnosed postmortem with thrombosis of the distal aorta, its branches and upper mesenteric artery which was not occluded on previous CTA, glomerulonephritis and pulmonary parenchymal granulomatous infiltrations.
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Affiliation(s)
| | - Robert Blažeković
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Surgery, Dubrava University Hospital, Zagreb, Croatia; 4Department of Pediatric Surgery, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Pathology and Forensic Medicine, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia
| | - Dalibor Divković
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Surgery, Dubrava University Hospital, Zagreb, Croatia; 4Department of Pediatric Surgery, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Pathology and Forensic Medicine, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia
| | - Ksenija Marjanović
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Surgery, Dubrava University Hospital, Zagreb, Croatia; 4Department of Pediatric Surgery, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Pathology and Forensic Medicine, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia
| | - Mirna Sipl
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Surgery, Dubrava University Hospital, Zagreb, Croatia; 4Department of Pediatric Surgery, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Pathology and Forensic Medicine, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia
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Sukharomana M, Viravan S, Piyaphanee N, Charuvanij S. Takayasu arteritis with an initial presentation of chronic monoarthritis mimicking oligoarticular juvenile idiopathic arthritis. Pediatr Rep 2018; 10:7648. [PMID: 30069294 PMCID: PMC6050474 DOI: 10.4081/pr.2018.7648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/24/2018] [Indexed: 11/22/2022] Open
Abstract
Patients with Takayasu arteritis (TA) generally present with non-specific symptoms that, if unrecognized and untreated, may develop vessel stenosis and/or aneurysm. There is limited data regarding chronic monoarthritis as the initial presentation in children with TA. We report a 6-yearold girl diagnosed and treated as oligoarticular juvenile idiopathic arthritis (JIA). She later developed stroke with malignant hypertension and was definitively diagnosed with TA. She additionally developed proteinuria secondary to focal segmental glomerulosclerosis. This is the report of a patient with chronic monoarthritis mimicking oligoarticular JIA which chronic monoarthritis was the presentation of TA. Since JIA is a diagnosis of exclusion, any atypical features of oligoarticular JIA should illuminate the possibility of an alternative diagnosis. Our literature review focused on musculoskeletal presentations of children with TA.
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Affiliation(s)
| | | | - Nuntawan Piyaphanee
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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The renal artery is involved in Chinese Takayasu’s arteritis patients. Kidney Int 2018; 93:245-251. [DOI: 10.1016/j.kint.2017.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/05/2017] [Accepted: 06/22/2017] [Indexed: 11/18/2022]
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Renal Vasculitis in Childhood. CURRENT PEDIATRICS REPORTS 2017. [DOI: 10.1007/s40124-017-0138-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Patel B, Tiwari A, Dubey SRK, Bhatt GC, Tiwari P, Bhan BD. Takayasu arteritis presenting with malignant hypertension; a rare manifestation of a rare disease: a case report and review of the literature. Trop Doct 2016; 47:60-63. [PMID: 27216226 DOI: 10.1177/0049475516648062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Takayasu arteritis (TA) is a chronic inflammatory and obliterative disease of large vessels, which mainly affects the aorta and its major branches. TA can lead to renal failure and renovascular hypertension in 60% of patients; it is rare in children aged <10 years and, more rarely, it presents with malignant hypertension in the paediatric age group. Here we present a case of 9-year-old boy with TA who presented with malignant hypertension and required surgical intervention to control the blood pressure. Subsequently, his medications were titrated using 24 h ambulatory blood pressure monitoring (ABPM) and is doing well on follow-up.
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Affiliation(s)
- Bhupeshwari Patel
- Senior Resident, Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Astha Tiwari
- Assistant Professor, Department of Paediatrics, Chirayu Medical College, Bhopal, Madhya Pradesh, India
| | - Shiv Ram Krishna Dubey
- Senior Resident, Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Girish C Bhatt
- Assistant Professor, Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Punit Tiwari
- Department of Urosurgery, Chirayu Medical College, Bhopal, Madhya Pradesh, India
| | - Bhavna Dhingra Bhan
- Assistant Professor, Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
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Batouche DD, Kerboua KE, Sadaoui L, Benhamed F, Zohret-Bouhalouane S, Boucherit N, Berexi-Reguig M, Elhalimi K, Benatta NF. [Clinical and etiological profile malignant hypertension in children in pediatric intensive care]. Ann Cardiol Angeiol (Paris) 2016; 65:165-70. [PMID: 27180561 DOI: 10.1016/j.ancard.2016.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Malignant hypertension (HTA), pediatrics, is unique by its clinical presentation, defined as severe hypertension accompanied by ischemic failure of one or more organs. METHODS-PATIENTS Retroprospective study of cases of children admitted to pediatric intensive care. We chose a decline of 10 years from September 1994 to December 2004 for the first time, and from January 2005 to December 2015 for the second period; and we identified the cases presenting malignant hypertension (mHTA). RESULTS Sixty-six patients were included, a prevalence of 0.6%. The age of patients ranged from 12months to 16years. The symptoms are related to the consequences of hypertension or condition in question. The most found signs are headache in more than 7%. Cerebrovascular event in 6%. A hypertensive convulsive encephalopathy 33.3% of patients. Renal disease is common, of varying severity. A fundus retinopathy was found in 47% stage 3, stage 4 in 51%. mHTA defined for the mean SBP values of 175mmHg and DBP average 112,5mmHg is often secondary to renal causes. The treatment is symptomatic with antihypertensive associated with the etiological treatment. Evolution is good out of 7 deaths. CONCLUSION mHTA is a rare condition in the pediatric population. The clinical signs of functional rich under their impact on vital organs. The support must be early in intensive care.
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Affiliation(s)
- D-D Batouche
- Service de réanimation pédiatrique CHU d'Oran, Oran, Algérie.
| | - K E Kerboua
- Service d'immunologie, HMRU Oran, Oran, Algérie
| | - L Sadaoui
- Service de néphrologie CHU d'Oran, Oran, Algérie
| | - F Benhamed
- Service de réanimation pédiatrique CHU d'Oran, Oran, Algérie
| | | | - N Boucherit
- Service de réanimation pédiatrique CHU d'Oran, Oran, Algérie
| | - M Berexi-Reguig
- Service de réanimation pédiatrique CHU d'Oran, Oran, Algérie
| | - K Elhalimi
- Service de réanimation pédiatrique CHU d'Oran, Oran, Algérie
| | - N-F Benatta
- Service de cardiologie, unité enfant, CHU d'Oran, Oran, Algérie
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Zhu G, He F, Gu Y, Yu H, Chen B, Hu Z, Liang W, Wang Z. Angioplasty for pediatric renovascular hypertension: a 13-year experience. Diagn Interv Radiol 2015; 20:285-92. [PMID: 24675165 DOI: 10.5152/dir.2014.13208] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the long-term outcome and efficacy of percutaneous transluminal renal angioplasty (PTRA) for pediatric renal artery stenosis (RAS), which is an important cause of medication-refractory pediatric hypertension. MATERIALS AND METHODS We retrospectively evaluated 22 hypertensive children (age range, 3-17 years) who underwent PTRA from February 2000 to July 2012. Sixteen patients had Takayasu arteritis and six fibromuscular dysplasia. Five were not included in the statistical analysis due to loss to follow-up. RESULTS Technical success was achieved in 32 of 34 procedures (94.1%). The stenosis rate decreased from 84.5% before PTRA to 20.1% after PTRA. Treatment was effective in 72.7% (16/22) of patients, including complete cure in 27.3% (6/22) and improvement in 45.5% (10/22). Systolic and diastolic blood pressures decreased from 153 ± 19.1 to 131.7 ± 21.4 mmHg and from 97.9 ± 14.2 to 83.6 ± 19.3 mmHg, respectively (P <0.01). Number of antihypertensive agents decreased from 2.7 to 0.5 per patient. Restenosis was detected in 40.9% (9/22) of patients, with a restenotic interval of 11.8 months (range, 3-47 months). Lesion length was strongly correlated with clinical success (cure and improvement) (independent-sample t test, P <0.001; binary logistic regression, P = 0.040). CONCLUSION Lesion length is an important determination of clinical success with PTRA for pediatric RAS. PTRA is an appropriate treatment option for pediatric renovascular hypertension due to Takayasu arteritis and fibromuscular dysplasia.
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Affiliation(s)
- Guangchang Zhu
- From the Department of Vascular Surgery Second Artillery General Hospital, Beijing Normal University, Beijing, China.
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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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Fukuda K, Shimizu A, Kaneko T, Masuda Y, Yasuda F, Fukui M, Higo S, Hirama A, Mii A, Tsuruoka S, Ohashi R, Iino Y, Fukuda Y, Katayama Y. A case of secondary focal segmental glomerulosclerosis associated with malignant hypertension. CEN Case Rep 2012; 2:68-75. [PMID: 28509227 DOI: 10.1007/s13730-012-0041-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/28/2012] [Indexed: 01/17/2023] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is associated with various clinicopathological conditions, including hypertension. We report here a case of secondary FSGS associated with malignant hypertension. A 33-year-old man with a 1-month history of visual impairment and headache visited the Department of Ophthalmology at our hospital and was found to have hypertensive retinopathy and severe hypertension (230/160 mmHg). He was referred to our department based on suspected renal dysfunction. His blood pressure on admission was 250/130 mmHg. Physical examination and laboratory tests revealed hypertensive cardiac dysfunction, focal brain edema, renal dysfunction (serum creatinine, Cr 7.07 mg/dl, blood urea nitrogen, BUN 49.9 mg/dl), massive proteinuria (10.7 g/day), and thrombotic microangiopathy. Funduscopy showed exudate, hemorrhage, and papilledema. The cause of secondary hypertension could not be identified. He was treated for primary malignant hypertension, but required hemodialysis 3 days after admission due to anuria. Treatment with antihypertensive agents resulted in the gradual recovery of renal function, although heavy proteinuria continued with nephrotic syndrome. Renal biopsy performed 1 month after admission showed features of malignant nephrosclerosis with secondary FSGS. Hemodialysis was discontinued following further improvement in renal function and the most recent laboratory tests showed proteinuria 1.8 g/day and persistent renal dysfunction (BUN 36.5 mg/dl, Cr 3.14 mg/dl). Malignant hypertension may cause various injuries, including glomerular endothelial and epithelial cell injuries in glomerular hypertension and hyperfiltration, increase of the renin-angiotensin-aldosterone system, and endothelial-epithelial interaction, resulting in the development of secondary FSGS and heavy proteinuria.
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Affiliation(s)
- Kumiko Fukuda
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, 1-15 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
| | - Tomohiro Kaneko
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Yukinari Masuda
- Department of Analytic Human Pathology, Nippon Medical School, 1-15 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Fumihiko Yasuda
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Megumi Fukui
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Seiichiro Higo
- Department of Analytic Human Pathology, Nippon Medical School, 1-15 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Akio Hirama
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Akiko Mii
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Shuichi Tsuruoka
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Ryuji Ohashi
- Division of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuhiko Iino
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuh Fukuda
- Department of Analytic Human Pathology, Nippon Medical School, 1-15 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Yasuo Katayama
- Division of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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15
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Affiliation(s)
- Ralph Kettritz
- Department of Nephrology and Intensive Care Medicine, Charité Virchow Klinikum, Experimental and Clinical Research Center, Berlin, Germany
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Brunner J, Feldman BM, Tyrrell PN, Kuemmerle-Deschner JB, Zimmerhackl LB, Gassner I, Benseler SM. Takayasu arteritis in children and adolescents. Rheumatology (Oxford) 2010; 49:1806-14. [PMID: 20562196 DOI: 10.1093/rheumatology/keq167] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Takayasu arteritis is a devastating vasculitis of the aorta and its major branches. The clinical manifestations in paediatric patients are less specific than in adults: in children the disease presents with fever, arthralgias and hypertension. Intramural inflammation results in narrowing of the blood vessel lumen and therefore hypoperfusion of the parenchyma. Conventional angiography is the gold standard diagnostic procedure. Corticosteroids, cyclophosphamide, MTX and biological therapies such as TNF-α blocking agents are treatment options.
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Affiliation(s)
- Juergen Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medical University Innsbruck, Innsbruck, Austria.
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Do classification criteria of Takayasu arteritis misdiagnose children with fibromuscular dysplasia? Pediatr Nephrol 2010; 25:989-90; author reply 991-2. [PMID: 20066441 DOI: 10.1007/s00467-009-1419-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
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Gimpel C, Schaefer F. Williams-Beuren syndrome--stretching to learn big lessons from small patients. Nephrol Dial Transplant 2009; 25:339-41. [DOI: 10.1093/ndt/gfp614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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