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Lupus Nefritine Benzeyen Klasik Poliarteritis Nodosa Olgu Sunumu

A Case of Classic Polyarteritis Nodosa Resembling Lupus Nephritis

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2014
DOI: 
10.5262/tndt.2014.1002.19

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Classic polyarteritis nodosa (cPAN) is a systemic necrotizing vasculitis of medium-sized muscular arteries. Glomerular involvement is not expected in the course of cPAN. Herein, we describe a case of cPAN with glomerular and multiple arterial involvement. The patient presented with severe abdominal pain and high fever. Urine analysis showed hematuria and 1g/day proteinuria. Kidney biopsy showed fibrinoid necrosis of arterioles and IgG, IgA and C1q positivity raising a suspicion of lupus nephritis. However digital subtraction angiography revealed typical multiple micro-aneurysms in the coronary, mesenteric, splenic and renal arteries establishing the diagnosis of cPAN. Kidney biopsy in cPAN may reveal non-specific immune-deposits and fibrinoid necrosis of arterioles mimicking lupus nephritis and microscopic polyangiitis. c-PAN should be carefully differentiated from these entities.
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Abstract (Original Language): 
Klasik poliarteritis nodosa (cPAN) orta boy musküler arterleri tutan sistemik nekrotizan bir vaskülittir. Klasik PAN’ın seyrinde glomerüler tutulum genelde beklenmemektedir. Burada glomerüler ve multipl arteryal tutulumu olan bir klasik PAN olgusu tartışılacaktır. Hasta ciddi karın ağrısı ve yüksek ateş nedeni ile başvurdu. İdrar tahlilinde hematüri ve 1 gr/gün proteinüri gözlendi. Böbrek biyopsisi yapıldı ve histolojide lupus nefritini düşündüren arterioler fibrinoid nekroz ve IgG, IgA, C1q pozitifliği görüldü. Buna karşın dijital subtraksiyon anjiyografide koroner, mesenterik, splenik ve renal arterlerde tipik multipl mikroanevrizmalar görülmesi üzerine cPAN tanısı kondu. Klasik PAN’ın böbrek biyopsisi non-spesifik immün deposit ve arterioler fibrinoid nekroz görünümü ile lupus nefritini ve mikroskopik polianjitisi taklit edebilir. Ayırıcı tanıda Klasik PAN bu antitelerden dikkatlice ayrılmalıdır.
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  • Turkish

REFERENCES

References: 

1. Sellar RJ, Mackay IG, Buist TA: The incidence of microaneurysms
in polyarteritis nodosa. Cardiovasc Intervent Radiol 1986; 9(3):
123-126
2. Griffith ME, Gaskin G, Pusey CD: Classification, pathogenesis, and
treatment of systemic vasculitis. Ren Fail 1996; 18(5): 785-802
3. Watts RA, Lane SE, Scott DG, Koldingsnes W, Nossent H,
Gonzalez-Gay MA, Garcia-Porrua C, Bentham GA: Epidemiology
of vasculitis in Europe. Ann Rheum Dis 2001; 60(12): 1156
4. Balow JE: Renal vasculitis. Kidney Int 1985; 27: 954
5. Bakkaloglu SA, Ekim M, Tümer N, Tulunay O, Ozer T: Severe
renal impairment in the case of classic polyarteritis nodosa. Pediatr
Nephrol 2001; 16(2): 148-150
6. Sakaguchi Y, Uehata T, Kawabata H, Niihata K, Shimomura A,
Suzuki A, Kaneko T, Shoji T, Shimazu K, Fushimi H, Tsubakihara
Y: An autopsy-proven case of myeloperoxidase-antineutrophil
cytoplasmic antibody-positive polyarteritis nodosa with acute renal
failure and alveolar hemorrhage. Clin Exp Nephrol 2011; 15(2):
281-284
7. Handa R, Wali JP, Gupta SD, Dinda AK, Aggarwal P, Wig N:
Classical polyarteritis nodosa and microscopic polyangiitis-a
clinicopathologic study. J Assoc Physicians India 2001; 49: 314-319
8. Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross
WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CG:
Nomenclature of systemic vasculitides. Proposal of an international
consensus conference. Arthritis Rheum 37: 187-192
9. Falk RJ, Jennette JC: Anti-neutrophil cytoplasmic autoantibodies
with specificity for myeloperoxidase in patients with
systemic vasculitis and idiopathic necrotizing and crescentic
glomerulonephritis. N Engl J Med 1988; 318: 1651-1657
10. Kastner D, Gaffney M, Tak T: Polyarteritis nodosa and myocardial
infarction. Can J Cardiol 2000; 16(4): 515
11. Churg A: Pathologic features of vasculitis. In: Ball GV, Bridges SL
(eds), Vasculitis. 2. Oxford: Oxford University Press, 2008;97-114
12. Ewald EA, Griffin D, McCune WJ: Correlation of angiographic
abnormalities with disease manifestations and disease severity in
polyarteritis nodosa. J Rheumatol 1987; 4: 952-956
13. Hekali P, Kajander H, Pajari R, Stenman S, Somer T: Diagnostic
significance of angiographically observed visceral aneurysms with
regard to polyarteritis nodosa. Acta Radiol 1991; 32: 143-148
14. Saddekni S, Horesh L, Leonardo R, Kasthuri S: Angiography
and percutaneous interventions. In: Ball GV, Bridges SL (eds),
Vasculitis. 2. Oxford: Oxford University Press, 2008; 227-245
15. Sabater EA, Stanson AW: Cross sectional imaging in vasculitis. In:
Ball GV, Bridges SL (eds), Vasculitis. 2. Oxford: Oxford University
Press, 2008; 247-265

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