Kidney involvement in medium- and large-vessel vasculitis.
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.
Nephrology Unit, University Hospital, Parma, Italy.
Federica
F
Maritati
Nephrology Unit, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Francesco
F
Iannuzzella
Nephrology Unit, University Hospital, Parma, Italy.
Maria P
MP
Pavia
Nephrology Unit, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Sonia
S
Pasquali
Nephrology Unit, University Hospital, Parma, Italy. augusto.vaglio@virgilio.it.
Augusto
A
Vaglio
D013700:Giant Cell Arteritis / Q000150:complications*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D010488:Polyarteritis Nodosa / Q000150:complications*; D012185:Retroperitoneal Fibrosis / Q000150:complications*; D013625:Takayasu Arteritis / Q000150:complications*
Giant-cell arteritis; IgG4; Periaortitis; Polyarteritis nodosa; Renal artery stenosis; Renal infarction; Retroperitoneal fibrosis; Takayasu arteritis