Presentation
Bilateral lesions and renal functional impairment at presentation were significantly predictive of poor outcomes. [jrheum.org]
Presenting demographics and disease parameters are summarized in Table 1. [acrabstracts.org]
She presented with fulminant and severe renal insufficiency due to crescentic glomerulonephritis. [link.springer.com]
We present four young patients who initially presented with hypertension due to RAS. Clinical criteria coupled with non-invasive studies in all four cases led to the diagnosis of Takayasu's arteritis. All four patients had good outcomes. [journals.lww.com]
Cardiac involvement and association with other diseases may also be present. We present in this report the case of an elderly patient with late diagnosis of Takayasu's arteritis and various comorbidities or related complications. [bjn.org.br]
Entire Body System
- Fever
A 64-year-old woman with hypertension and hyperlipidemia was admitted to our hospital for the investigation and management of general fatigue, anorexia, a 5-kg weight loss, and a 4-week history of high-grade fever. [ncbi.nlm.nih.gov]
Abstract A 64-year-old woman with hypertension and hyperlipidemia was admitted to our hospital for the investigation and management of general fatigue, anorexia, a 5-kg weight loss, and a 4-week history of high-grade fever. [jstage.jst.go.jp]
It can cause: extreme tiredness a high temperature (fever) weight loss muscle and joint pain dizziness shortness of breath painful, numb or cold limbs Treatment is usually with steroid medication. [nhs.uk]
- Malaise
[…] multinucleated giant cells Can produce either luminal compromise (more common) or dilatation and aneurysms Us. young women, most often Asian or European background, us. onset age 10-30y Initial presentation includes fever, arthralgias, arthritis, and malaise [faculty.washington.edu]
Comment: In summary, this 73 year old male with a three month history of constitutional symptoms including weight loss, night sweats, fatigue and malaise presents with rapidly progressive acute renal failure, hemoptysis and diffuse bilateral pulmonary [path.upmc.edu]
Constitutional symptoms may include weight loss, malaise, fever, depression, and polymyalgia rheumatica, night sweats [1] [5] [6] [10] [4]. [physio-pedia.com]
Takayasu's arteritis affects the thoracic and abdominal aorta and its main branches or the pulmonary arteries. 17 It primarily affects young women, particularly of Asian descent, and may be manifested by malaise, arthralgias and the gradual onset of extremity [aafp.org]
Systemic symptoms occur to 20-80% of patients and are characterized by fatigue, malaise, weight loss, arthralgias, and myalgias. [rheumatologyadvisor.com]
- Gangrene
Clinicopathologic features and calcium deposition patterns in calciphylaxis: comparison with gangrene, peripheral artery disease, chronic stasis, and thrombotic vasculopathy. Am J Surg Pathol 2019; 43:1273-1281. X. [ojs.reumatologia.org.ar]
[…] infrequent and, according to Vale et al ., this combination raises the possibility of a common immunological basis in the pathogenesis of both diseases. 1, 12 In advanced cases, the occlusion of arterial vessels of the limbs may result in ischemic ulcers or gangrene [scielo.br]
Palpable purpura Postcapillary venules Any type of vasculitis except giant cell arteritis and Takayasu's arteritis Skin ulcers Arterioles to small arteries Polyarteritis, Churg-Strauss vasculitis, Wegener's granulomatosis, hypersensitivity vasculitis Gangrene [aafp.org]
- Rapidly Progressive Glomerulonephritis
Contributor's Note: Crescentic glomerulonephritis or rapidly progressive glomerulonephritis (RPGN) is a term given to a diverse group of diseases which all have cresents present within the glomerular tuft (Table 1). [path.upmc.edu]
Renal involvement may present as a rapidly progressive glomerulonephritis(GN) with renal biopsy showing a pauci-immune crescentic GN. [rarerenal.org]
Confusingly, approximately 5% of pauci-immune, crescentic glomerulonephritis is ANCA negative at diagnosis. The typical presentation of renal vasculitis is that of a rapidly progressive glomerulonephritis. [cjasn.asnjournals.org]
- Fever of Unknown Origin
An additional cause for fever of unknown origin. Minn Med. 1983 Jan; 66 (1):33–34. [ PubMed ] [ Google Scholar ] Truong L, Kopelman RG, Williams GS, Pirani CL. Temporal arteritis and renal disease. Case report and review of the literature. [ncbi.nlm.nih.gov]
Additionally, giant cell arteritis is a common cause of fever of unknown origin in the elderly. 16 Patients with giant cell arteritis are almost always over age 50 and have an ESR over 50 mm per hour (“the rule of 50s”). [aafp.org]
Cardiovascular
- Hypertension
Takayasu arteritis associated renal artery stenosis (TARAS) is the biggest cause of hypertension in young people <40 years old. Hypertension caused by renal artery stenosis is usually hard to control in spite of two or more anti-hypertension drugs. [clinicaltrials.gov]
However, an important differential for hypertension in the young Asian population is Takayasu's arteritis. We present four young patients who initially presented with hypertension due to RAS. [journals.lww.com]
Among the 13 with hypertension including two who developed hypertension over the follow-up period; 11 were on anti-hypertensive drugs. Among the six patients with renal asymmetry ; five were known and one developed this over the follow-up period. [acrabstracts.org]
Case study, Radiopaedia.org (Accessed on 29 Mar 2023) https://doi.org/10.53347/rID-10240 Case published: 24 Jul 2010 Case of the day: 08 Nov 2010 Presentation Young hypertensive woman, referred for evaluation of hypertension. [radiopaedia.org]
The outcome of hypertension was defined as follows: (1) cured (normotensive off anti-hypertensives), (2) improved (normotensive on same or reduced number of medications), or (3) failure (no cure or improvement in number of medications). [link.springer.com]
- Vascular Disease
Vascular Manifestations of Systemic Autoimmune Diseases not only describes the clinical symptoms of vascular diseases; it also covers in one volume the many mechanisms involved in the pathogenesis of these disorders and addresses the newest treatments [books.google.de]
What is renal vascular disease? Renal vascular disease is the name given to a variety of complications that affect the arteries and veins of the kidneys. [unmc.edu]
In the clinical trials of peripheral vascular disease, it has been confirmed that DCB had lower re-stenosis rate than PTA. However, up to date, no studies was found about the use of DBC in TARAS. [clinicaltrials.gov]
Brest A, Heider C and Moyer J (1962) Renal vascular disease as a cause of hypertension∗, The American Journal of Cardiology, 10.1016/0002-9149(62)90136-4, 9:5, (748-755), Online publication date: 1-May-1962. [ahajournals.org]
[…] disorders of arteries and arterioles 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 2 Excludes collagen (vascular) diseases ( M30-M36 ) hypersensitivity angiitis ( M31.0 ) pulmonary artery ( I28.- ) Other disorders of arteries and arterioles [icd10data.com]
- Tachycardia
The patient's workup showed a pulse rate of 104 beats/min, cardiomegaly and signs of cephalization on chest X-ray [Figure 1], and sinus tachycardia on electrocardiography. [rcvmonline.com]
She continued under medical care at a basic healthcare unit in her own district, where she used to present nonspecific symptoms such as fatigue, diffuse arthralgia, dizziness, intermittent claudication, diffuse myalgia, tachycardia, and depressive symptoms [scielo.br]
Skin
- Subcutaneous Nodule
In patients with “cutaneous polyarteritis nodosa”, the findings of the disease are localized to the skin (purpura or subcutaneous nodules), but also sometimes the peripheral nerve(s) of the same limb (causing weakness and/or numbness). [vasculitisfoundation.org]
Musculoskeletal
- Hip Pain
Patients with giant cell arteritis typically present with headaches affecting the temples, scalp tenderness, jaw pain and fatigue with chewing, shoulder or hip pain and stiffness, and/or sudden changes in vision (temporary or permanent blindness or partial [vasculitisfoundation.org]
Neurologic
- Seizure
[…] claudication of the jaw or extremities, back pain (due to involvement of the aorta), syncope (rare), hypertension (the most common presentation in children). [ 4, 5 ] Neurological - dizziness, headaches, transient ischaemic attacks (TIAs), visual disturbance, seizures [patient.info]
Complications of the disease include the following: Stroke Intracranial hemorrhage Seizures Graft stenosis and/or occlusion Ischemia Organ failure Complications of hypertension (eg, aortic dissection [18] ) Fetal injury Valvular heart disease Retinopathy [emedicine.medscape.com]
Eclampsia is defined by the presence of seizures in a patient with signs of preeclampsia. [kidneypathology.com]
- Sciatica
DEZOBISNUIRE DE ALCOOL - DEZOBISNUIRE DE SOMNIFERE - DEZOBISNUIRE DE TUTUN - NEURASTENIE - DISTONIE NEUROVEGETATIVA - TRANSPIRATIE EXCESIVA ( HIPERHIDROZA ) - NERVOZITATE - INSOMNIE - MIGRENE CU TULBURARI DE SOMN - CEFALEE - NEVRALGIE FACIALA, INTERCOSTALA SI SCIATICA [homeopatie.ro]
Urogenital
- Oliguria
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. [bjnephrology.org]
In one of these visits, she complained of recent oliguria, slowness, drowsiness and hair loss. Her laboratory tests showed TSH 66.09 mIU/L; free T 4 of 0.53 ng/dL; creatinine of 5.58 mg/dL and urea of 172 mg/dL. [scielo.br]
STEC-HUS : This form, also called the classical form, presents after or during an episode of diarrheal disease, there is acute renal failure with oliguria, proteinuria, hematuria, anemia and thrombocytopenia. [kidneypathology.com]
- Anuria
Renal‐artery stenosis in a solitary kidney should be considered as a cause of anuria with an excellent prognosis when revascularization is initiated early. [academic.oup.com]
Early onset anuria and acute kidney injury are rare and have been reported only in a few cases in the literature. [bjnephrology.org]
Case Report A 34-year-old male, a known case of TA, was admitted in our hospital with flash pulmonary edema, pleural effusion, anuria, and an elevated creatinine level. [rcvmonline.com]
The severity of systemic hypertension and duration of anuria are also factors related to prognosis. In up to 39% of cases there is residual renal damage after HUS ( Kern WF, Silva GF, et al, Atlas of Renal Pathology. [kidneypathology.com]
- Testicular Pain
[…] out other diagnoses-->Creatinine, muscle LFTs, Hep B and C, UA, elevated ESR and CRP -CXR and blood cultures bc you can't miss endocarditis and sepsis -Document vasculitis plus 3 of the following: --Weight loss greater than 4 kg --Livedo reticularis --Testicular [quizlet.com]
Similarly, in a patient who presents with a multisystem illness and testicular pain and swelling, a testicular biopsy should be considered. Sural nerve biopsy may be indicated in a patient with numbness and tingling in a lower extremity. [aafp.org]
Workup
Progress logically from the histologic pattern, through the appropriate workup, around the pitfalls, to the best diagnosis. [books.google.es]
Serological workup revealed a high-titre perinuclear antinuclear cytoplasmic antibody and antibodies to myeloperoxidase. Renal biopsy demonstrated a pauci-immune focal crescentic glomerulonephritis. [casereports.bmj.com]
Initial workup revealed BUN 62mg/dl, creatinine 2.8mg/dl, random urine protein 76mg/dl with 24-hour urine protein 576mg but no urine RBCs, ESR 81mm/hr, CRP 170mg/l, total CPK 245u/l, and positive MPO-ANCA with titer >8. [shmabstracts.com]
The patient's workup showed a pulse rate of 104 beats/min, cardiomegaly and signs of cephalization on chest X-ray [Figure 1], and sinus tachycardia on electrocardiography. [rcvmonline.com]
Angiography-based categories Takayasu arteritis can be divided into the following six types based on angiographic involvement (see Workup ) [3] : Type I - Branches of the aortic arch Type IIa - Ascending aorta, aortic arch, and its branches Type IIb - [emedicine.medscape.com]
X-Ray
- Small Kidney
The clinical significance of arteritis of the small kidney arteries has not been evaluated in detail. [jasn.asnjournals.org]
As a result, there are increased blood levels of the hormone angiotensin 2, which causes narrowing of the small blood vessels in the kidneys. [medicinenet.com]
Kidney Int 96: 246–247, 2019 Keywords: ANCA; ANCA renal risk score; risk factors; small kidney arteries arteritis; histopathological classification Copyright © 2021 by the American Society of Nephrology [journals.lww.com]
Treatment
Diagnosis and surgical treatment of a Takayasu disease on an abdominal aortic dissection. Ann Vasc Surg 2011; 25: 556.e1-5. Ando M, Okita Y, Tagusari O, Kitamura S, Matsuo H. [termedia.pl]
In addition, the prognosis of TA has improved with the available treatment modalities [14]. [openurologyandnephrologyjournal.com]
Abstract We report a case of biopsy-proven temporal arteritis and polymyalgia rheumatica with improved clinical symptoms with steroid treatment but with subsequent renal failure while on steroids. [ncbi.nlm.nih.gov]
She was started on a drug treatment for vasculitis with deflazacort at 30 mg/day. [scielo.br]
She was started on a drug treatment for vasculitis with deflazacort at 30 mg/day. Figure 1. [bjn.org.br]
Prognosis
AAV_A+ patients were distributed in all categories of the current prognosis’ classification. [jasn.asnjournals.org]
In addition, the prognosis of TA has improved with the available treatment modalities [ 14 Ohigashi H, Haraguchi G, Konishi M. [benthamopen.com]
One study suggested that a low ESR, early treatment with steroids and a stable condition at presentation were factors which predicted a good prognosis. [ 17 ] [patient.info]
Our results suggest renal prognosis is better than previously thought. Disclosure: C. Baldwin, None; A. Mohammad, None; D. [acrabstracts.org]
[…] presentation of TA, we recommend a high clinical index of suspicion of renal artery involvement and sufficient heed to its significance especially in view of the fact that its early diagnosis and timely appropriate treatment can confer a much better prognosis [rcvmonline.com]
Etiology
Etiology The etiology of Takayasu arteritis is unknown. [emedicine.medscape.com]
Persistent perplexing pyrexia: some comments on etiology and diagnosis. Med Clin North Am. 1970 Mar; 54 (2):379–396. [ PubMed ] [ Google Scholar ] Barbado FJ, Vázquez JJ, Peña JM, Arnalich F, Ortiz-Vázquez J. [ncbi.nlm.nih.gov]
Since then, this procedure has been performed successfully several times and become the alternative treatment to the surgical approach with better results in pediatric patients. [7] To sum up, TA with renal artery involvement must be regarded as an etiologic [rcvmonline.com]
Presumed to be due to etiologies similar to those responsible for native kidney glomerulonephritis Hyperacute Rejection Rejection presumed to be due to preformed antibody, usually characterized by polymorph accumulation in glomerular and peritubular capillaries [tpis.upmc.com]
Abnormal artery biopsy with either mononuclear cell infiltrate or granulomatous inflammation (with giant cells) Etiology/Causes The overall etiology of GCA is unkown [3]. [physio-pedia.com]
Epidemiology
In this review, we present the epidemiology, clinical manifestations, diagnosis and treatment of Takayasu's arteritis with particular emphasis on renal artery stenosis. [ncbi.nlm.nih.gov]
Epidemiology of Takayasu arteritis. Presse Med 2017;46:e197-e203. 4. Jokar MH, Takayasu arterities in Iran. SAS J Med 2016;2:64-8. 5. Valente ES, de Almeida R, Sacco AG, Lazzarin MC, da Silva AM, Andreazza M, et al. [rcvmonline.com]
Takayasu's arteritis was first described by Mikito Takayasu in 1908. [ 3 ] Epidemiology [ 3 ] Takayasu's arteritis is rare. [patient.info]
Pathophysiology
Written by leading pathologists, this second edition presents an up-to-date, concise presentation of major pathological, clinical, pathophysiological, and genetic information for over 240 diagnoses. [books.google.es]
From basic science and pathophysiology to clinical best practices, Brenner & Rector’s The Kidney is your go-to resource for any stage of your career. [books.google.com]
Large artery vasculitides Takayasu's arteritis Pathophysiology Involves the aorta (us. the most severely affected vessel) and its primary branches, including renal and mesenteric aa. [faculty.washington.edu]
Other pathophysiologic consequences include hypotensive ischemic retinopathy, vertebrobasilar ischemia, microaneurysms, carotid stenosis, hypertensive encephalopathy, and inflammatory bowel disease. [emedicine.medscape.com]
Prevention
An antiplatelet agent was prescribed to prevent thrombotic complications. At 3 months after initiation of treatment, the patient remained normotensive. [ped-rheum.biomedcentral.com]
Appropriate local and systemic therapy has to be initiated for other organ manifestations and to prevent recurrence of the disease. [academic.oup.com]
[…] disease if you have: Diabetes Family history of kidney disease Heart disease High blood pressure High cholesterol African Americans are about 3.5 times more likely to develop kidney disease than Caucasians, according to the Centers for Disease Control and Prevention [arthritis.org]
The long-term steroid use is to prevent the progression of the disease in other segments that may have TA involvement, such as the brachiocephalic and visceral vessels. References Takayasu M. [jvascsurg.org]