Takayasu's Arteritis Associated With Glomerulonephritis

Abstract

Takayasu's disease is a nonspecific arteritis of unknown cause with predilection for the aortic arch and its branches; approximately 20% of those affected are children or adolescents, predominantly females. The purpose of this article is to report the case of a young girl in which the mode of presentation was microscopic hematuria and proteinuria. Subsequently, aortic valvular insufficiency developed and there was evidence of aortitis in the thoracic and abdominal aorta, as well as in the arch. All functional and anatomical cardiac derangements were documented by ultrasound and angiocardiography. Renal biopsies showed progressive glomerular involvement characterized by focal and segmental glomerulonephritis. It is postulated that a common immunologic mechanism was responsible for the aortic and glomerular lesions.

Renal Histological Studies in Patients with Takayasu’s Arteritis

“…Electron microscopy confirmed electron-dense deposits in the same areas. This is in keeping with the few isolated cases of glomerular disease associated with TA, in which focal and segmental glomerulonephritis with mesangial deposits of immunoglobulin (IgG, IgA, IgM) and comple ment (C3, C4, Clq) were demonstrated [8,9]. These find ings can lead to the hypothesis that the glomerular lesions result from trapping of circulating immune complexes formed at the affecting arteries by the kidney.…”

“…Clinical manifestations are variable de pending upon the sites and grades of the affecting arteries [3][4][5][6][7], Primary glomerular alterations are not generally considered to be associated with TA, although a few iso lated cases of TA with glomerular disease have been re ported [8,9]. The present study describes the clinical and renal histological features in 3 patients with TA, and suggests that some common immunologic mechanisms exist between the aortic and glomerular lesions.…”

Membranoproliferative Glomerulonephritis in Takayasu’s Arteritis

“…The remaining case showed no deposition of immuno globulin or complement [10], Electron microscopy showed mesangial electron-dense material in 3 cases [7,8,10] and segmental effacement of foot processes in another [10]. Repeated renal biopsy, performed in 2 cases, showed in both a progression of histologic changes along with a worsening of urinary findings [7,8].…”

Glomerulonephritis associated with Takayasu arteritis

“…Glomerulonephritis is a rarely seen complication of Takayasu arteritis. There have been less than 100 cases reported in the literature, with the earliest in 1978 [22]. In a recent case-based review published by Ito et al [4], a literature searched produced 76 cases of glomerulonephritis associated with Takayasu arteritis.…”