A review of Takayasu's arteritis in children in Gauteng, South Africa
Autor: | Solomon E. Levin, Udai Kala, Thomson Pd, Deirdré Hahn, Peter Beale |
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Rok vydání: | 1998 |
Předmět: |
Male
Nephrology medicine.medical_specialty Adolescent Takayasu's arteritis South Africa Internal medicine medicine.artery Humans Medicine Arteritis Child Retrospective Studies Immunosuppression Therapy Tomography Emission-Computed Single-Photon medicine.diagnostic_test business.industry Vascular disease Abdominal aorta Mantoux test medicine.disease Combined Modality Therapy Takayasu Arteritis Surgery Treatment Outcome Child Preschool Pediatrics Perinatology and Child Health Female business Complication Vasculitis |
Zdroj: | Pediatric Nephrology. 12:668-675 |
ISSN: | 1432-198X 0931-041X |
Popis: | We have reviewed 31 patients with Takayasu's arteritis followed at two pediatric nephrology units in Gauteng, South Africa over a 15-year period. There were 25 black patients, 4 white, and 2 of mixed race. The mean age at diagnosis was 8.42+/-3.59 (range 2.4-14.5, median 8) years. The most common presenting sign was hypertension, followed by cardiac failure, bruits, and absent pulses. The Mantoux test was strongly positive in 27 patients (90%, control population 5%). Markers of activity included a raised erythrocyte sedimentation rate (23 patients) or Gallium single photon emission tomography (positive in 12 of 16 patients). Angiography revealed type II (abdominal aorta) and III (arch plus abdominal aorta) lesions to be most common (11 in each group). All patients received antituberculous therapy and most low-dose aspirin for its antithromboxane effect. Corticosteroids and further immunosuppression were used to control disease activity. We added total lymphoid irradiation (TLI) or cyclophosphamide. Twenty-six patients in all received further immunosuppression, with 13 patients in each group. Results were similar in the two groups, with similar pre- and posttherapy systolic blood pressures and creatinine clearances. Two patients in each group relapsed, 3 died in the TLI group and 2 in the cyclophosphamide group. Surgical intervention, usually in the quiescent phase, consisted mainly of renal autotransplantation. Because of the problems with TLI and 2 patients with papillary carcinoma of the thyroid with long-term follow-up, we no longer use TLI. We have shown that with active medical and surgical intervention the aggressive course of this disease in children can be modified. |
Databáze: | OpenAIRE |
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