Ruptured renal artery in microscopic polyangiitis: a case report and literature review

Autor: Mariko Endo, Sachiko Wakai, Ayumi Ishiwatari
Rok vydání: 2018
Předmět:
Nephrology
medicine.medical_specialty
medicine.medical_treatment
Renal Hemorrhage
030232 urology & nephrology
Microscopic Polyangiitis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Hemorrhage
Case Report
Kidney
03 medical and health sciences
0302 clinical medicine
Renal Artery
Renal Dialysis
Internal medicine
medicine.artery
medicine
Rapidly progressive glomerulonephritis
Humans
Embolization
Renal artery
Anti-neutrophil cytoplasmic antibody
030203 arthritis & rheumatology
Aged
80 and over
Rupture
Hematoma
Antibiotics
Antineoplastic
medicine.diagnostic_test
business.industry
General Medicine
medicine.disease
Embolization
Therapeutic
Surgery
Treatment Outcome
Kidney Failure
Chronic
Female
Steroids
Renal biopsy
Ribonucleosides
business
Microscopic polyangiitis
Tomography
X-Ray Computed
Zdroj: CEN case reports. 7(2)
ISSN: 2192-4449
Popis: Medium-vessel hemorrhage is a rare occurrence in ANCA-associated vasculitis, and has been previously described in only a few patients with microscopic polyangiitis. We report a case of renal hemorrhage in a patient with microscopic polyangiitis that was successfully managed by transcatheter arterial embolization of the active bleeding sites. The early clinical findings included necrotizing arteritis, as indicated by skin biopsy; rapidly progressive glomerulonephritis; mononeuritis multiplex; positive screening for myeloperoxidase-specific antineutrophil cytoplasmic antibody. Corticosteroid therapy was initiated. The patient’s health deteriorated at 1 week, with rapidly progressing anemia. Computerized tomography identified a large, right-sided, perirenal hematoma, with active bleeding. Bleeding was successfully managed via segmental embolization of the renal artery. The patient was treated with steroid therapy and MZR, and subsequently underwent maintenance hemodialysis treatment for end-stage renal disease. Spontaneous renal hemorrhage is a rare but fatal clinical condition. A ruptured renal artery should be considered in a patient with microscopic polyangiitis, even in the absence of previous trauma and renal biopsy, when unexplained anemia or signs of shock occur.
Databáze: OpenAIRE
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