Abstract: SA-PO298
Takayasu’s Arteritis Induced Bilateral Renal Artery Stenosis Refractory to Medical Therapy
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Kumar, Rahul, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
- Nakhoul, Georges, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
- Taliercio, Jonathan J., Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
Group or Team Name
- Cleveland Clinic Foundation
Introduction
Takayasu’s arteritis (TAK) is a granulomatous large-vessel vasculitis. It primarily affects women of age 10 to 40 years. In patients with TAK, the prevalence of hypertension varies from 23% to 76% across the world and about half of the case are secondary to renal artery involvement. In this study, we present a patient with difficult to control hypertension and worsening renal function secondary to TAK induced renal artery stenosis in spite of adequate medical management.
Case Description
A 39-year-old Caucasian female presented with sudden onset chest pain, left arm pain, muscle ache, and 50-pound weight loss over the past one year. Patient has a past medical history of multiple sclerosis, ulcerative colitis, and cigarette smoking. On exam, blood pressure was 110/72 mmHg in the right arm and 88/70 mmHg in the left arm. A left subclavian bruit was present with a feeble left radial pulse. EKG showed an anterior STEMI. A coronary angiogram revealed 99% LAD ostial stenosis and incidentally showed high-grade stenosis of the proximal left subclavian and bilateral renal arteries. The patient underwent an urgent coronary artery bypass graft. On further workup, a CT angiogram showed severe stenosis of the proximal left subclavian artery, superior and inferior mesenteric artery, celiac artery and bilateral renal artery (80% RRA and 90% LRA stenosis). A clinical diagnosis of Takayasu’s arteritis was made and the patient was started on prednisone and methotrexate. At a six-month follow-up, the patient was found to have BP of 160/90 mmHg in spite of being on four antihypertensives including an ACE-I and a decreased eGFR of 40 ml/min/1.73m2. MRA abdomen showed a completely occluded right renal artery with an atrophied right kidney. Renal Duplex US showed LRA proximal stenosis with a significantly increased PSV of 760 cm/sec and RRI of 60%. An aortogram confirmed the RRA occlusion. The patient underwent left aorto-renal bypass grafting of her solitary kidney. A six-month follow-up showed improved eGFR to 76 ml/min/1.73m2 and a decrease in antihypertensive medicines to carvedilol and enalapril.
Discussion
In TAK with advanced renal artery stenosis refractory to medical therapy, endovascular or surgical revascularization is the treatment of choice. The patient was prevented from becoming dialysis dependent by the timely recognition, close monitoring, and intervention.