Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Rheumatol Int. 2023 Feb;43(2):391-398. doi: 10.1007/s00296-021-05066-0. Epub 2022 Jan 11.
Although Takayasu arteritis (TAK) is a form of large vessel vasculitis, complications of glomerulonephritis have occasionally been observed, with mesangial proliferative glomerulonephritis as the most common. The aim of this work was to present a case-based review regarding the association of glomerulonephritis and IgA nephropathy (IgAN) with TAK. A literature search was carried out using the PubMed and Scopus databases for articles published in English, and the Ichu-shi Web for Japanese. A 34-year-old Japanese man was evaluated for proteinuria, and IgAN was diagnosed by renal biopsy. Simultaneously, aortic wall thickening and right renal artery stenosis confirmed a coexisting TAK. Prednisolone and methotrexate improved both diseases, and percutaneous transluminal renal angioplasty resulted in right renal artery reopening. Our case and literature review revealed that membranous proliferative glomerulonephritis and IgAN are common in eastern Asia, while focal segmental glomerulosclerosis and mesangial proliferative glomerulonephritis are common in other regions. The incidence of IgAN is higher in TAK cases and is mostly reported in Asia. Abdominal aortic involvement and renal artery stenosis are common in cases with preceding TAK. IgAN could be related to the cytokine network involving interleukin-6, suggesting the usefulness of tocilizumab in patients with TAK accompanied by IgAN. The type of glomerulonephritis complicated with TAK differs among regions, and patients with TAK are more likely to experience IgAN than the healthy population.
虽然 Takayasu 动脉炎（TAK）是一种大血管血管炎，但偶尔也会观察到肾小球肾炎的并发症，其中以系膜增生性肾小球肾炎最为常见。本研究旨在通过病例报告回顾，探讨肾小球肾炎和 IgA 肾病（IgAN）与 TAK 的关联。使用 PubMed 和 Scopus 数据库以及 Ichu-shi Web 对发表在英文文献中的文章进行了文献检索。一名 34 岁的日本男性因蛋白尿接受评估，肾活检诊断为 IgAN。同时，主动脉壁增厚和右肾动脉狭窄证实并存 TAK。泼尼松龙和甲氨蝶呤改善了这两种疾病，经皮腔内肾血管成形术导致右肾动脉再通。我们的病例和文献复习表明，膜性增生性肾小球肾炎和 IgAN 在东亚很常见，而局灶节段性肾小球硬化和系膜增生性肾小球肾炎在其他地区很常见。IgAN 在 TAK 病例中的发病率更高，主要在亚洲报道。腹主动脉受累和肾动脉狭窄在有 TAK 病史的病例中很常见。IgAN 可能与涉及白细胞介素 6 的细胞因子网络有关，这表明托珠单抗在伴有 IgAN 的 TAK 患者中的有效性。伴有 TAK 的肾小球肾炎的类型在不同地区有所不同，与健康人群相比，TAK 患者更有可能发生 IgAN。
