Boubaker Karima, Kaaroud Hayet, Goucha Rim, Kheder Adel
Service de médecine interne A (M8), hôpital Charles-Nicolle, boulevard du 9 avril, 1006 Bab, Souika, Tunis, Tunisie.
Service de médecine interne A (M8), hôpital Charles-Nicolle, boulevard du 9 avril, 1006 Bab, Souika, Tunis, Tunisie.
Nephrol Ther. 2014 Nov;10(6):451-6. doi: 10.1016/j.nephro.2014.07.483. Epub 2014 Oct 23.
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.
高安动脉炎累及肾脏很常见，会加重疾病进展。主要表现为肾动脉狭窄导致肾血管性高血压。肾小球疾病较为罕见。本研究旨在确定与高安动脉炎相关的肾脏疾病患者的临床、放射学、生物学特征及治疗反应。对11例患者（5例男性和6例女性）进行了回顾性病历审查，平均年龄为31.1岁（19 - 40岁）。8例患者在高安动脉炎诊断之前就已发现肾脏疾病。10例患者出现高血压。实验室检查发现5例有蛋白尿，其中1例为肾病综合征。6例出现肾衰竭，包括4例终末期慢性肾衰竭。9例患者存在肾动脉损害，7例为近端损害，2例为远端损害，5例为双侧损害，4例为单侧损害。7例发现肾动脉狭窄。肾活检显示1例为膜增生性肾小球肾炎，另1例为肾硬化。11例患者平均随访155个月（3 - 335个月）。肾病综合征缓解与疾病缓解同时出现。7例患者出现高安动脉炎发作，其中6例接受治疗。肾病综合征复发与疾病发作同时出现，随后两种疾病均自发缓解。5例血压得到改善，7例肾功能恶化。观察到2例死亡。
