Renal manifestations in toddlers with Takayasu's arteritis and malignant hypertension.
Three children under the age of 3 years presented with malignant hypertension, proteinuria, and acute kidney injury. Takayasu's arteritis was diagnosed on the basis of clinical symptoms of weight loss and low grade fever in conjunction with elevated sedimentation rate and radiographic evidence of aortic and renal artery stenosis. One patient had a renal biopsy which showed arteriolar sclerosis and focal glomerulosclerosis. All three patients required multiple antihypertensive agents, ultimately including angiotensin receptor blockers and/or angiotensin converting enzyme inhibitors. The vasculitis was treated with pulse corticosteroids followed by cyclophosphamide in one patient and mycophenolate mofetil as maintenance therapy in all. Follow-up has ranged from 2 to 8 years. Although global renal function has normalized in each patient, two have unilateral non-function of one kidney. The last patient has persistent aortic and renal artery stenosis with complex collateralization requiring ongoing medical and anticipated surgical management.
Hijazi
Rana
R
Division of Pediatric Nephrology, Department of Pediatrics, University of Miami/Holtz Children's Hospital, Miami, FL, USA.
Chandar
Jayanthi
J
Nwobi
Obioma
O
Muneeruddin
Samina
S
Zilleruelo
Gastón
G
Abitbol
Carolyn L
CL
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001706:Biopsy; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D006974:Hypertension, Malignant / Q000188:drug therapy* / Q000601:surgery; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007668:Kidney / Q000503:physiopathology / Q000601:surgery; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D012078:Renal Artery Obstruction / Q000188:drug therapy* / Q000601:surgery; D013625:Takayasu Arteritis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid