Takayasu arteritis: differential diagnosis in a teenager with severe acute kidney injury - a case report

ABSTRACT 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.

【摘要】高安动脉炎（Takayasu arteritis, TA）是一种病因不明的慢性肉芽肿性炎症性疾病，主要累及大血管——尤其是主动脉及其分支，如颈动脉、冠状动脉、肺动脉及肾动脉。左锁骨下动脉为最常受累的血管。肾动脉狭窄在23%~31%的病例中被报道，可引发恶性高血压、缺血性肾病、失代偿性心力衰竭及早亡。双侧肾动脉受累较为少见。早期起病无尿与急性肾损伤罕见，目前仅在少数文献病例中有所报道。
本病例报告介绍1例15岁女性患者，其全身症状持续进展达1年，伴随头痛、恶心与呕吐，且多次急诊就诊，但临床检查不充分。症状出现6个月后，患者病情显著恶化，出现急性肺水肿、少尿、急性肾损伤及难以控制的高血压，遂收入重症监护病房并行血液透析。首次超声检查显示患者肾脏形态正常，肾动脉无狭窄。住院30天后，患者仍无尿，行肾活检提示肾脏组织未见异常。腹部主动脉计算机断层血管造影（Computed Tomography Angiography）扫描显示双侧肾动脉闭塞。该患者符合高安动脉炎的诊断标准，且出现了文献中鲜有描述的严重并发症：缺血性肾病急性期双侧肾动脉狭窄。