Renal Failure in Temporal Arteritis

Abstract

We report a case of biopsy-proven temporal arteritis and polymyalgia rheumatica with improved clinical symptoms with steroid treatment but with subsequent renal failure while on steroids. Kidney biopsy showed focal segmental necrotizing glomerulonephritis with crescents and small-vessel vasculitis. Treatment with methylprednisolone and cyclophosphamide achieved normalization of renal function. We emphasize the importance of kidney biopsy because of its therapeutic implications. The previous literature concerning renal disease in temporal arteritis is discussed.

End-Stage Renal Disease after Necrotising Glomerulonephritis in an Elderly Patient with Temporal Arteritis

“…Small and Brisson [I] have recently reported a patient with Wegener's granulo matosis affecting the kidneys presenting as TA. Finally, Canton et al [2] have reported a patient similar to ours, but with a good renal outcome after immunosuppressive treatment with cyclophosphamide and steroids.…”

“…The poor response to steroid therapy of renal disease in our patient, with TA easily controlled with low-dose steroids, pleads against a common pathogenetic mechanism between both fea tures and underscores the need of more ag gressive immunosuppressive therapy. Only one reported patient has survived with func tioning kidneys and was treated with cyclo phosphamide [2]. Our patient is the first case with TA and renal vasculitis leading to endstage renal disease and further need of main tenance hemodialysis.…”

“…Dear Sir, Small and Brisson [1] and Canton et al [2] have recently reported patients with temporal arteritis (TA) and renal involvement. In addi tion, biopsy-proven glomerular disease and/ or intrarenal vasculitis has been reported in a few patients with TA [3][4][5][6][7][8], It is debated whether these are related disorders or only chance associations.…”

Giant cell arteritis: ophthalmic manifestations of a systemic disease

“…Renal involvement in GCA is rare though cases of GCA causing small vessel vasculitis and necrotising glomerulonephritis with resulting renal failure have been described [104].…”

Hypokalemic Metabolic Alkalosis Secondary to Giant Cell Arteritis

“…Nevertheless, amyloidosis can be reasonably ruled out, since Congo red staining of the biopsy specimens of the gastric and temporal arteries proved negative. Other alterations previously described were nephrotic-range proteinuria [1], hematuria, granulomatous renal vasculitis with renal insufficiency [6,7], and aneurysm of the renal artery [8].We were unable to find in the literature a description of the biochemical alterations found in our patient -hypokalemic alkalosis due to secondary hyperaldosteronism. The stenosis of the renal artery revealed by MRI…”