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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2020  |  Volume : 31  |  Issue : 5  |  Page : 1148-1149
The Overlap of Inflammatory and Fixed Lesions in Takayasu's Arteritis


1 Department of Nephrology, Dialysis and Renal Transplant, ARNAS Civico e Di Cristina Hospital, Palermo, Italy
2 Department of Radiology, ARNAS Civico e Di Cristina Hospital, Palermo, Italy

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Date of Web Publication21-Nov-2020
 

How to cite this article:
Li Cavoli G, Bono L, Finazzo F, Vallone MG, Tortorici C, Azzolina V, Utri RD, Li Cavoli TV, Mongiovi R, Amato A, Servillo F, Oliva B, Schillaci O. The Overlap of Inflammatory and Fixed Lesions in Takayasu's Arteritis. Saudi J Kidney Dis Transpl 2020;31:1148-9

How to cite this URL:
Li Cavoli G, Bono L, Finazzo F, Vallone MG, Tortorici C, Azzolina V, Utri RD, Li Cavoli TV, Mongiovi R, Amato A, Servillo F, Oliva B, Schillaci O. The Overlap of Inflammatory and Fixed Lesions in Takayasu's Arteritis. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2020 Dec 2];31:1148-9. Available from: https://www.sjkdt.org/text.asp?2020/31/5/1148/301186


Dear Editor,

Takayasu's arteritis (TA) is a rare, large-vessel vasculitis, which has severe prognosis, unknown etiology, and higher prevalence in young Asian women. Most of the recent studies report the predominance of female patients in different ethnicities, age >40, worldwide distribution, coexistence of both acute inflammatory and chronic fixed lesions, and improved prognosis of TA. The assessment of TA activity is usually challenging as vascular inflammation may progress to fixed vascular injury without findings of active disease.[1] Renal artery stenosis could occur as a consequence of arterial wall thickening due to atherosclerosis secondary to prolonged inflammation[2]. We report our experience on the overlap of inflammatory acute and fixed chronic lesions in TA. A 62-year-old Caucasian woman, a heavy smoker, with a body mass index of 28 kg/m2, without metabolic and immunological diseases history, and suffering from hypertensive disease, was referred to the nephrology department for evaluation of bilateral renal arterial stenosis and severe arterial hypertension. Doppler ultrasound, angio-computed tomography, and angio-magnetic resonance imaging identified bilateral carotid atheromasia without hemodynamic relevance and left proximal subclavian arterial stenosis with flow reversal in the left vertebral artery. MR angiogram identified intense signs of edema in the left subclavian artery wall. Renal arterial arteriography showed severe bilateral stenosis [Figure 1]. On physical examination, we found tensive difference between the arms (40 mm Hg > on the right arm), decreased left brachial artery pulse, and a vascular bruit on the left side of her neck. Immunological and microbio-logical investigations were negative; blood count, proteinuria, renal function, glycemia, and lipid metabolism tests were within the normal ranges. The cardiac performance was normal. Fundus oculi showed initial hypertensive retinopathy. The patient met four of the six Amercian College of Rheumatology criteria and of five of the six European League Against Rheumatism (EULAR) criteria for TA classification. She underwent transcutaneous balloon angioplasty of renal arteries with bilateral stenting. From this experience, we observed chronic fixed lesions (renal arterial stenosis) along with acute inflammatory activity findings (intense edema in the left subclavian artery wall). Probably, the TA's natural history, characterized by subacute, relapsing, often pauci symptomatic phases with variable evolution of vascular lesions in chronic ischemic outcomes, influences its clinical manifestation.[3] Although there is often a delay in the TA diagnosis, due to different presentation and nonspecific symptoms, the development of noninvasive diagnostic imaging tools, earlier diagnosis, and more effective medical treatments have helped improve long-term TA prognosis in the last decades.
Figure 1: Renal artery arteriography; red arrow: right renal artery stenosis; yellow arrow: left renal artery stenosis.

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Acknowledgments

The authors would like to thank Miss Chiara Rondello for her contribution to the translation of the article.

Conflict of interest: None declared.



 
   References Top

1.
Vanoli M, Daina E, Salvarani C, et al. Takayasu's arteritis: A study of 104 Italian patients. Arthritis Rheum 2005;53:100-7.  Back to cited text no. 1
    
2.
Li Cavoli G, Mulè G, Vallone MG, Caputo F. Takayasu's disease effects on the kidneys: Current perspectives. Int J Nephrol Renovasc Dis 2018;11:225-33.  Back to cited text no. 2
    
3.
Direskeneli H. Clinical assessment in Takayasu's arteritis: Major challenges and controversies. Clin Exp Rheumatol 2017;35: 189-93.  Back to cited text no. 3
    

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Correspondence Address:
Gioacchino Li Cavoli
Department of Nephrology, Dialysis and Renal Transplant, ARNAS Civico e Di Cristina Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.301186

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