Skip to main content

Advertisement

SpringerLink
Log in

Kidney involvement in medium- and large-vessel vasculitis

  • Review
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

Abstract

Medium- and large-vessel vasculitides (MVV and LVV, respectively) comprise a heterogeneous group of disorders whose common denominator is the inflammatory involvement of vessels of medium and large size. This disease spectrum includes giant-cell arteritis and Takayasu’s arteritis, which typically affect the aorta and its main branches, and Kawasaki’s disease and polyarteritis nodosa, which involve medium-sized arteries. Chronic periaortitis, characterized by a perivascular fibro-inflammatory reaction affecting the abdominal aorta and the periaortic tissue, frequently has a systemic distribution, involving other segments of the aorta and its major branches, and could thus be included in this group. Unlike small-vessel vasculitides, MVV and LVV do not cause glomerulonephritis, although glomerular immune-mediated lesions and tubulo-interstitial nephritis occur with varying frequency. However, MVV and LVV can often involve the renal artery and its branches, causing a wide array of lesions that range from renal artery stenosis to intra-renal vasculitis causing renal ischaemia/infarction, microaneurysms and haemorrhage. This review focuses on renal involvement in MVV and LVV and underlines why renal abnormalities in these syndromes should not be overlooked.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Watts RA, Scott DG (1997) Classification and epidemiology of the vasculitides. Baillieres Clin Rheumatol 11(2):191–217

    Article  CAS  PubMed  Google Scholar 

  2. Lightfoot RW Jr et al (1990) The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 33(8):1088–1093

    Article  PubMed  Google Scholar 

  3. Jennette JC et al (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37(2):187–192

    Article  CAS  PubMed  Google Scholar 

  4. Jennette JC et al (2013) 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65(1):1–11

    Article  CAS  PubMed  Google Scholar 

  5. Palmisano A et al (2015) Chronic periaortitis with thoracic aorta and epiaortic artery involvement: a systemic large vessel vasculitis? Rheumatology (Oxford) 54(11):2004–2009

    Article  Google Scholar 

  6. Gonzalez-Gay MA et al (2005) Giant cell arteritis: disease patterns of clinical presentation in a series of 240 patients. Medicine (Baltimore) 84(5):269–276

    Article  Google Scholar 

  7. Hutchinson J (1890) Diseases of the arteries. On a peculiar form of thrombotic arteries of the aged which is sometimes productive of gangrene. Arch Surg 1:323–329

    Google Scholar 

  8. Salvarani C, Cantini F, Hunder GG (2008) Polymyalgia rheumatica and giant-cell arteritis. Lancet 372(9634):234–245

    Article  PubMed  Google Scholar 

  9. Hunder GG et al (1990) The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 33(8):1122–1128

    Article  CAS  PubMed  Google Scholar 

  10. Carmona FD et al (2015) A large-scale genetic analysis reveals a strong contribution of the HLA class II region to giant cell arteritis susceptibility. Am J Hum Genet 96(4):565–580

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hailwood SJ et al (1999) Granulomatous vasculitis: an unusual renal vasculitis. Nephrol Dial Transplant 14(4):952–953

    Article  CAS  PubMed  Google Scholar 

  12. Scarpioni R et al (2003) Isolated renal giant cell arteritis, not so rare a cause of renal failure? Am J Kidney Dis 41(3):720

    Article  PubMed  Google Scholar 

  13. Truong L et al (1985) Temporal arteritis and renal disease. Case report and review of the literature. Am J Med 78(1):171–175

    Article  CAS  PubMed  Google Scholar 

  14. Moraga S et al (2001) Giant cell arteritis and renal amyloidosis: report of a case. Clin Nephrol 56(5):402–406

    CAS  PubMed  Google Scholar 

  15. Lie JT (1995) Aortic and extracranial large vessel giant cell arteritis: a review of 72 cases with histopathologic documentation. Semin Arthritis Rheum 24(6):422–431

    Article  CAS  PubMed  Google Scholar 

  16. Pipitone N, Versari A, Salvarani C (2008) Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update. Rheumatology (Oxford) 47(4):403–408

    Article  CAS  Google Scholar 

  17. Matteson EL et al (2016) Glucocorticoids for Management of Polymyalgia Rheumatica and Giant Cell Arteritis. Rheum Dis Clin North Am 42(1):75–90

    Article  PubMed  Google Scholar 

  18. Tann OR, Tulloh RM, Hamilton MC (2008) Takayasu’s disease: a review. Cardiol Young 18(3):250–259

    Article  PubMed  Google Scholar 

  19. Arend WP et al (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33(8):1129–1134

    Article  CAS  PubMed  Google Scholar 

  20. Vanoli M et al (2005) Takayasu’s arteritis: a study of 104 Italian patients. Arthritis Rheum 53(1):100–107

    Article  CAS  PubMed  Google Scholar 

  21. Lagneau P, Michel JB (1985) Renovascular hypertension and Takayasu’s disease. J Urol 134(5):876–879

    CAS  PubMed  Google Scholar 

  22. Lai KN, Chan KW, Ho CP (1986) Glomerulonephritis associated with Takayasu’s arteritis: report of three cases and review of literature. Am J Kidney Dis 7(3):197–204

    Article  CAS  PubMed  Google Scholar 

  23. de Pablo P et al (2007) Kidney involvement in Takayasu arteritis. Clin Exp Rheumatol 25(1 Suppl 44):S10–S14

    PubMed  Google Scholar 

  24. Sharma BK, Jain S, Radotra BD (1998) An autopsy study of Takayasu arteritis in India. Int J Cardiol 66(Suppl 1):S85–S90 (discussion S91)

    Article  PubMed  Google Scholar 

  25. Boubaker K et al (2014) Renal injury in Takayasu’s arteritis. Nephrol Ther 10(6):451–456

    Article  PubMed  Google Scholar 

  26. Palmisano A, Vaglio A (2009) Chronic periaortitis: a fibro-inflammatory disorder. Best Pract Res Clin Rheumatol 23(3):339–353

    Article  PubMed  Google Scholar 

  27. Parums DV (1990) The spectrum of chronic periaortitis. Histopathology 16(5):423–431

    Article  CAS  PubMed  Google Scholar 

  28. van Bommel EF et al (2009) Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation. Medicine (Baltimore) 88(4):193–201

    Article  Google Scholar 

  29. Vaglio A et al (2007) Retroperitoneal fibrosis: evolving concepts. Rheum Dis Clin North Am 33(4):803–817 (vi–vii)

    Article  PubMed  Google Scholar 

  30. Martorana D et al (2006) Chronic periaortitis and HLA-DRB1*03: another clue to an autoimmune origin. Arthritis Rheum 55(1):126–130

    Article  CAS  PubMed  Google Scholar 

  31. Boiardi L et al (2011) CC chemokine receptor 5 polymorphism in chronic periaortitis. Rheumatology (Oxford) 50(6):1025–1032

    Article  CAS  Google Scholar 

  32. Goldoni M et al (2014) Asbestos and smoking as risk factors for idiopathic retroperitoneal fibrosis: a case-control study. Ann Intern Med 161(3):181–188

    Article  PubMed  Google Scholar 

  33. Pelkmans LG et al (2012) Value of acute-phase reactants in monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Nephrol Dial Transplant 27(7):2819–2825

    Article  CAS  PubMed  Google Scholar 

  34. Yamamoto M et al (2012) Value of serum IgG4 in the diagnosis of IgG4-related disease and in differentiation from rheumatic diseases and other diseases. Mod Rheumatol 22(3):419–425

    Article  CAS  PubMed  Google Scholar 

  35. Brandt AS et al (2011) Associated findings and complications of retroperitoneal fibrosis in 204 patients: results of a urological registry. J Urol 185(2):526–531

    Article  CAS  PubMed  Google Scholar 

  36. Kermani TA et al (2011) Idiopathic retroperitoneal fibrosis: a retrospective review of clinical presentation, treatment, and outcomes. Mayo Clin Proc 86(4):297–303

    Article  PubMed  PubMed Central  Google Scholar 

  37. Vaglio A et al (2011) Prednisone versus tamoxifen in patients with idiopathic retroperitoneal fibrosis: an open-label randomised controlled trial. Lancet 378(9788):338–346

    Article  CAS  PubMed  Google Scholar 

  38. Vaglio A, Pipitone N, Salvarani C (2011) Chronic periaortitis: a large-vessel vasculitis? Curr Opin Rheumatol 23(1):1–6

    Article  PubMed  Google Scholar 

  39. Scheel PJ Jr, Feeley N (2009) Retroperitoneal fibrosis: the clinical, laboratory, and radiographic presentation. Medicine (Baltimore) 88(4):202–207

    Article  Google Scholar 

  40. Palmisano A et al (2009) Peri-renal collateral circles. Urology 74(2):292–293

    Article  PubMed  Google Scholar 

  41. Sakata N et al (2008) IgG4-positive plasma cells in inflammatory abdominal aortic aneurysm: the possibility of an aortic manifestation of IgG4-related sclerosing disease. Am J Surg Pathol 32(4):553–559

    Article  PubMed  Google Scholar 

  42. Vaglio A et al (2002) ANCA-positive periaortic vasculitis: does it fall within the spectrum of vasculitis? J Intern Med 251(3):268–271

    Article  CAS  PubMed  Google Scholar 

  43. Khosroshahi A et al (2013) Rethinking Ormond’s disease: “idiopathic” retroperitoneal fibrosis in the era of IgG4-related disease. Medicine (Baltimore) 92(2):82–91

    Article  CAS  Google Scholar 

  44. Corradi D et al (2007) Idiopathic retroperitoneal fibrosis: clinicopathologic features and differential diagnosis. Kidney Int 72(6):742–753

    Article  CAS  PubMed  Google Scholar 

  45. Kottra JJ, Dunnick NR (1996) Retroperitoneal fibrosis. Radiol Clin North Am 34(6):1259–1275

    CAS  PubMed  Google Scholar 

  46. Salvarani C et al (2005) Positron emission tomography (PET): evaluation of chronic periaortitis. Arthritis Rheum 53(2):298–303

    Article  PubMed  Google Scholar 

  47. Kardar AH et al (2002) Steroid therapy for idiopathic retroperitoneal fibrosis: dose and duration. J Urol 168(2):550–555

    Article  CAS  PubMed  Google Scholar 

  48. Warnatz K et al (2005) Immunosuppressive treatment of chronic periaortitis: a retrospective study of 20 patients with chronic periaortitis and a review of the literature. Ann Rheum Dis 64(6):828–833

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Hernandez-Rodriguez J et al (2014) Diagnosis and classification of polyarteritis nodosa. J Autoimmun 48–49:84–89

    Article  PubMed  Google Scholar 

  50. Watts RA et al (2000) Epidemiology of systemic vasculitis: a 10-year study in the United Kingdom. Arthritis Rheum 43(2):414–419

    Article  CAS  PubMed  Google Scholar 

  51. Trepo C, Thivolet J (1970) Hepatitis associated antigen and periarteritis nodosa (PAN). Vox Sang 19(3):410–411

    Article  CAS  PubMed  Google Scholar 

  52. Guillevin L et al (2005) Hepatitis B virus-associated polyarteritis nodosa: clinical characteristics, outcome, and impact of treatment in 115 patients. Medicine (Baltimore) 84(5):313–322

    Article  Google Scholar 

  53. Navon Elkan P et al (2014) Mutant adenosine deaminase 2 in a polyarteritis nodosa vasculopathy. N Engl J Med 370(10):921–931

    Article  PubMed  Google Scholar 

  54. Pagnoux C et al (2010) Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum 62(2):616–626

    Article  PubMed  Google Scholar 

  55. el-Reshaid K et al (1997) The spectrum of renal disease associated with microscopic polyangiitis and classic polyarteritis nodosa in Kuwait. Nephrol Dial Transplant 12(9):1874–1882

    Article  CAS  PubMed  Google Scholar 

  56. Cohen RD, Conn DL, Ilstrup DM (1980) Clinical features, prognosis, and response to treatment in polyarteritis. Mayo Clin Proc 55(3):146–155

    CAS  PubMed  Google Scholar 

  57. Gorriz JL et al (1997) Renal-limited polyarteritis nodosa presenting with loin pain and haematuria. Nephrol Dial Transplant 12(12):2737–2739

    Article  CAS  PubMed  Google Scholar 

  58. Kaur JS, Goldberg JP, Schrier RW (1982) Acute renal failure following arteriography in a patient with polyarteritis nodosa. JAMA 247(6):833–834

    Article  CAS  PubMed  Google Scholar 

  59. Wang AY et al (1996) Acute renal failure induced by angiotensin converting enzyme inhibitor in a patient with polyarteritis nodosa. Ren Fail 18(2):293–298

    Article  CAS  PubMed  Google Scholar 

  60. Ladefoged J et al (1969) Acute anuria due to polyarteritis nodosa. Am J Med 46(5):827–831

    Article  CAS  PubMed  Google Scholar 

  61. Schlesinger M et al (1989) Perirenal and renal subcapsular haematoma as presenting symptoms of polyarteritis nodosa. Postgrad Med J 65(767):681–683

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Peterson C Jr et al (1970) Polyarteritis nodosa with bilateral renal artery aneurysms and perirenal haematomas: angiographic and nephrotomographic features. Br J Radiol 43(505):62–66

    Article  PubMed  Google Scholar 

  63. Romijn JA et al (1989) Bilateral kidney rupture with severe retroperitoneal bleeding in polyarteritis nodosa. Neth J Med 35(5–6):260–266

    CAS  PubMed  Google Scholar 

  64. Hekali PE et al (1984) Bilateral renal artery dissections: unusual complication of polyarteritis nodosa. Eur J Radiol 4(1):6–8

    CAS  PubMed  Google Scholar 

  65. Glanz I, Grunebaum M (1976) Ureteral changes in polyarteritis nodosa as seen during excretory urography. J Urol 116(6):731–733

    CAS  PubMed  Google Scholar 

  66. Travers RL et al (1979) Polyarteritis nodosa: a clinical and angiographic analysis of 17 cases. Semin Arthritis Rheum 8(3):184–199

    Article  CAS  PubMed  Google Scholar 

  67. Schmidt WA (2004) Use of imaging studies in the diagnosis of vasculitis. Curr Rheumatol Rep 6(3):203–211

    Article  PubMed  Google Scholar 

  68. Guillevin L et al (2011) The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore) 90(1):19–27

    Article  Google Scholar 

  69. Ribi C et al (2010) Treatment of polyarteritis nodosa and microscopic polyangiitis without poor-prognosis factors: a prospective randomized study of one hundred twenty-four patients. Arthritis Rheum 62(4):1186–1197

    Article  PubMed  Google Scholar 

  70. Guillevin L et al (2003) Treatment of polyarteritis nodosa and microscopic polyangiitis with poor prognosis factors: a prospective trial comparing glucocorticoids and six or twelve cyclophosphamide pulses in sixty-five patients. Arthritis Rheum 49(1):93–100

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Nephrology Unit, University Hospital, Parma, Italy

      Federica Maritati, Maria P. Pavia & Augusto Vaglio

    2. Nephrology Unit, Arcispedale S. Maria Nuova, Reggio Emilia, Italy

      Francesco Iannuzzella & Sonia Pasquali

    Authors
    1. Federica Maritati
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Francesco Iannuzzella
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Maria P. Pavia
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Sonia Pasquali
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Augusto Vaglio
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Augusto Vaglio.

    Ethics declarations

    Ethical standards

    The authors declare that the present manuscript was written in accordance with the Ethical Rules of the Journal of Nephrology. For this type of manuscript (review paper with no original data), no specific consent was required.

    Conflict of interest

    None of the authors has any kind of conflict of interest with the publication of this article.

    Additional information

    Drs F. Maritati and F. Iannuzzella contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Maritati, F., Iannuzzella, F., Pavia, M.P. et al. Kidney involvement in medium- and large-vessel vasculitis. J Nephrol 29, 495–505 (2016). https://doi.org/10.1007/s40620-016-0303-8

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s40620-016-0303-8

    Keywords

    Search

    Navigation