Takayasu arteritis: differential diagnosis in a teenager with severe acute kidney injury - a case report
Autor: | Adriana Banhos Carneiro, Flávio Bezerra de Araújo, Nara Thaisa Tenório Martins Braga, Kathia Liliane da Cunha Ribeiro Zuntini, Elizabeth De Francesco Daher |
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Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
medicine.medical_treatment Case Reports 030204 cardiovascular system & hematology lcsh:RC870-923 urologic and male genital diseases 03 medical and health sciences Lesão Renal Aguda 0302 clinical medicine medicine.artery Internal medicine Medicine Renal artery Computed tomography angiography Hipertensão Arterial 030203 arthritis & rheumatology Aorta medicine.diagnostic_test business.industry Abdominal aorta Acute kidney injury General Medicine Acute Kidney Injury lcsh:Diseases of the genitourinary system. Urology medicine.disease Takayasu Arteritis Arterite de Takayasu Heart failure Hypertension Cardiology Anuria Hemodialysis medicine.symptom business |
Zdroj: | Brazilian Journal of Nephrology, Issue: ahead, Published: 10 JAN 2019 Jornal Brasileiro de Nefrologia Brazilian Journal of Nephrology, Iss 0 (2019) |
ISSN: | 2175-8239 0101-2800 |
DOI: | 10.1590/2175-8239-jbn-2018-0174 |
Popis: | Takayasu arteritis (TA) is a chronic granulomatous inflammatory condition of unknown cause that involves large vessels - particularly the aorta and its branches - such as the carotid, coronary, pulmonary, and renal arteries. The left subclavian artery is the most frequently involved vessel. Stenosis of the renal artery has been reported in 23-31% of the cases and may result in malignant hypertension, ischemic renal disease, decompensated heart failure, and premature death. Involvement of both renal arteries is uncommon. Early onset anuria and acute kidney injury are rare and have been reported only in a few cases in the literature. This report describes the case of a 15-year-old female with constitutional symptoms evolving for a year, combined with headache, nausea, and vomiting, in addition to frequent visits to emergency services and insufficient clinical examination. The patient worsened significantly six months after the onset of symptoms and developed acute pulmonary edema, oliguria, acute kidney injury, and difficult-to-control hypertension, at which point she was admitted for intensive care and hemodialysis. Initial ultrasound examination showed she had normal kidneys and stenosis-free renal arteries. The patient was still anuric after 30 days of hospitalization. A biopsy was performed and revealed her kidneys were normal. Computed tomography angiography scans of the abdominal aorta presented evidence of occlusion of both renal arteries. The patient met the diagnostic criteria for Takayasu arteritis and had a severe complication rarely described in the literature: stenosis of the two renal arteries during the acute stage of ischemic renal disease. RESUMO A Arterite de Takayasu (AT) é uma doença inflamatória crônica, granulomatosa, de causa desconhecida, que afeta grandes vasos, principalmente a aorta e seus ramos, incluindo artérias carótidas, coronárias, pulmonares e renais, sendo a artéria subclávia esquerda o vaso mais acometido. A estenose da artéria renal é relatada em 23-31% dos casos e pode resultar em hipertensão maligna, insuficiência renal por isquemia, descompensação cardíaca e morte prematura. O acometimento bilateral de artérias renais é incomum, sendo rara a presença de anúria súbita e lesão renal aguda como sintoma inicial da doença, com poucos relatos na literatura. O caso reporta uma adolescente de 15 anos com sintomas constitucionais durante um ano de evolução, associados a problemas como cefaleia, náuseas e vômitos, com idas frequentes a serviços de emergência, sem adequada investigação clínica. Após 6 meses do início dos sintomas, a paciente evoluiu de forma grave, com quadro de edema agudo de pulmão, oligúria, lesão renal aguda e hipertensão arterial de difícil controle, sendo necessário suporte em Unidade de Terapia Intensiva e hemodiálise. A ultrassonografia inicial mostrava rins normais e artérias renais sem sinais de estenose. Após 30 dias de internamento, paciente permanecia anúrica, sendo realizada biópsia renal que se mostrou dentro dos padrões da normalidade. Angiotomografia de aorta abdominal evidenciou oclusão bilateral de artérias renais. A paciente descrita fechou critérios diagnósticos para arterite de Takayasu e manifestou uma complicação grave pouco descrita na literatura: estenose bilateral de artérias renais, ainda na fase aguda da nefropatia isquêmica. |
Databáze: | OpenAIRE |
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