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 Table of Contents  
LETTER TO THE EDITOR
Year : 2022  |  Volume : 22  |  Issue : 3  |  Page : 179-180

Takayasu arteritis presenting as renal infarction


1 Department of General Medicine, Nizar Hospital, Valancheri, India
2 Department of Radiodiagnosis, Moulana Hospital, Perinthalmanna, Kerala, India

Date of Submission15-Mar-2022
Date of Acceptance22-Apr-2022
Date of Web Publication22-Jul-2022

Correspondence Address:
Dr. Mansoor C Abdulla
Department of General Medicine, Nizar Hospital, Valancheri 676552, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jesnt.jesnt_11_22

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How to cite this article:
Abdulla MC, Anand RR. Takayasu arteritis presenting as renal infarction. J Egypt Soc Nephrol Transplant 2022;22:179-80

How to cite this URL:
Abdulla MC, Anand RR. Takayasu arteritis presenting as renal infarction. J Egypt Soc Nephrol Transplant [serial online] 2022 [cited 2022 Dec 4];22:179-80. Available from: http://www.jesnt.eg.net/text.asp?2022/22/3/179/351709



Sir

A 50-year-old woman was admitted with high-grade fever with chills, vomiting, and dull aching right-side flank pain for four days. She had type 2 diabetes mellitus for the last 8 years and was on oral hypoglycemic agents. Examination showed feeble left radial pulse (all other peripheral pulsations were normal) and left subclavian bruit. Blood pressure was 160/90 mmHg in the right upper and 90/60 mmHg in the left upper limb. Abdominal examination showed right renal angle tenderness.

Investigations showed neutrophilic leukocytosis (total leukocyte count 16 900/μl with 80% neutrophils), elevated erythrocyte sedimentation rate (58 mm in 1 h), few red blood cells in the urine, and elevated blood urea (99 mg/dl) and serum creatinine (1.8 mg/dl). Ultrasonography finding of the abdomen was normal. Computed tomography of the abdomen showed a wedge-shaped hypodense area in the right kidney. Computed tomography aortic angiogram showed occlusion of the right internal carotid artery (Fig. 1]a), eccentric luminal narrowing of left subclavian artery ([Fig. 1]a), subtle concentric thickening of the aortic arch wall, narrowed ostium of the right renal artery with irregular process extension to mid-third, mild concentric thickening of the infrarenal segment of the abdominal aorta, and multiple right-side renal infarcts ([Fig. 1]b,[c],[d]). Antinuclear antibody, anti-neutrophilic cytoplasmic antibody, rheumatoid factor, and serologies for hepatitis B, C, and HIV were negative. She was diagnosed to have Takayasu arteritis (based on American College of Rheumatology criteria) with multiple renal infarcts and was treated with pulse steroid (methylprednisone 1000 mg intravenously for three doses) followed by oral prednisone 1 mg/kg daily.
Figure 1: Computed tomography aortic angiogram and reformatted computed tomography angiography showing occlusion of the right internal carotid artery, eccentric luminal narrowing of left subclavian artery (a), narrowed ostium of the right renal artery with irregular process extension to mid-third, mild concentric thickening of the infrarenal segment of the abdominal aorta and multiple right side renal infarcts(b–d).

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Renal vascular involvement in Takayasu arteritis is common (incidence varies from 11.5 to 62%) and causes renovascular hypertension [1]. The renal artery involvement is often bilateral and frequently ostial and proximal, but renovascular dilatative and aneurysmal lesions are rare [1]. Renovascular hypertension is the major renal problem caused by Takayasu arteritis. Asian populations have a higher incidence of renal vascular involvement in Takayasu arteritis than the rest of the world. Renal infarction is usually secondary to a thromboembolic phenomenon secondary to cardiac disease and hypercoagulability states [2]. Renal infarction secondary to Takayasu arteritis is rare and was previously reported only once in a 9-year-old female child [3].

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Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cavoli GL, Mulè G, Vallone MG, Caputo F Takayasu’s disease effects on the kidneys: current perspectives. Int J Nephrol Renovasc Dis 2018; 11:225.  Back to cited text no. 1
    
2.
Saeed K Renal infarction. Int J Nephrol Renovasc Dis 2012; 5:119.  Back to cited text no. 2
    
3.
Kanase ND, Ethiraj D, Indiran V Imaging of takayasu arteritis with renal infarct. Indian J Rheumatol 2021; 16:227–228.  Back to cited text no. 3
    


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