Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
Department of Rheumatology, Beijing Jishuitan Hospital, Beijing, China.
Kidney Int. 2018 Jan;93(1):245-251. doi: 10.1016/j.kint.2017.06.027. Epub 2017 Aug 31.
Takayasu's arteritis is a rare systemic vasculitis mainly affecting the aorta and its major branches. Previous studies have suggested that almost half of the Asian Takayasu's patients have renal artery involvement. However, due to the rarity of the disease, little is known about renal artery involvement in Chinese Takayasu's arteritis patients. Here, we retrospectively reviewed and analyzed 411 patients diagnosed with Takayasu's arteritis in our center to explore the clinical features of renal artery involvement in this group of patients. Of these, 201 patients were diagnosed to have renal artery involvement, with stenosis (78.1%) the most common renal artery pattern. Compared to those without, patients with renal artery involvement were significantly younger at disease onset (23.5 vs 25.6 years) and more frequently had hypertension (74.6% vs 28.1%). Congestive heart failure (22.4% vs 7.6%) and pulmonary hypertension (19.9% vs 9.5%) were both significantly more prevalent among patients with than those without renal artery involvement. The estimated glomerular filtration rate (eGFR) significantly decreased as the severity of renal artery stenosis increased. Age at disease onset older than 24 years (odds ratio 6.06 [95% Confidence Interval 2.76-13.3]), disease duration longer than 19 months (3.35 [1.52-7.4]) and renal artery involvement (8.7 [3.8-20.1]) were independent risk factors for renal dysfunction (eGFR under 90 mL/min/1.73m) among patients with Takayasu's arteritis. Thus, patients with renal artery involvement have more severe cardiac and renal dysfunction compared to those without. The eGFR is correlated negatively with the severity of renal artery stenosis.
大动脉炎是一种罕见的系统性血管炎，主要影响主动脉及其主要分支。既往研究提示，近半数亚洲大动脉炎患者存在肾动脉受累。然而，由于该疾病罕见，对于中国大动脉炎患者的肾动脉受累情况知之甚少。在此，我们回顾性分析了在本中心诊断的 411 例大动脉炎患者，旨在探讨该组患者肾动脉受累的临床特征。其中，201 例患者被诊断为肾动脉受累，狭窄（78.1%）是最常见的肾动脉受累模式。与无肾动脉受累者相比，肾动脉受累者的发病年龄明显更小（23.5 岁 vs 25.6 岁），且更常发生高血压（74.6% vs 28.1%）。充血性心力衰竭（22.4% vs 7.6%）和肺动脉高压（19.9% vs 9.5%）在肾动脉受累者中均更为常见。随着肾动脉狭窄严重程度的增加，估算肾小球滤过率（eGFR）显著降低。发病年龄＞24 岁（优势比 6.06 [95%置信区间 2.76-13.3]）、病程＞19 个月（3.35 [1.52-7.4]）和肾动脉受累（8.7 [3.8-20.1]）是大动脉炎患者发生肾功能不全（eGFR＜90 mL/min/1.73m）的独立危险因素。因此，与无肾动脉受累者相比，肾动脉受累者的心脏和肾脏功能更差。eGFR 与肾动脉狭窄严重程度呈负相关。
