RESEARCH ARTICLE


Takayasu’s Arteritis: An Uncommon Cause of Renal Artery Stenosis and Therapeutic Considerations



Mary Virmani11 , Luis Ortega 2 , Loay Salman1 , Tushar Vachharajani 3 , Arif Asif4 , Ali Nayer * , 1
1 Division of Nephrology and Hypertension, University of Miami, Miami, FL, USA
2 Division of Nephrology and Hypertension, Allegheny General Hospital, WPAHS, Pittsburg, PA, USA
3 Division of Nephrology and Hypertension W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC, USA
4 Division of Nephrology and Hypertension, Albany Medical College, Albany, NY, USA


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© Buffington et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Clinical Research Building, Suite 825, 1120 NW 14th St., Miami, FL 33136, USA; Tel: 305.243.8491; Fax: 305.243.3506; E-mail: ANayer@med.miami.edu


Abstract

Takayasu’s arteritis is a rare disorder characterized by granulomatous and necro-inflammatory disease of the aorta and its major branches. Its etiology remains unknown. We report a young woman with Takayasu’s arteritis affecting the aortic arch, carotid, mesenteric, celiac and bilateral renal arteries resulting in severe hypertension, unilateral renal atrophy and renal insufficiency. The immunosuppressive therapy did not halt the progression of her vascular disease, which required revascularization procedures on numerous occasions. Here, the clinical manifestations and histopathological features of Takayasu’s arteritis are reviewed. In addition, the available medical treatment options including glucocorticoids, cytotoxic agents and TNF-alpha inhibitors are discussed. Furthermore, current revascularization procedures such as percutaneous transluminal angioplasty and reconstructive vascular surgery in the treatment of occlusive vasculopathy due to Takayasu’s arteritis are discussed. Although the prognosis of this debilitating disease has improved over the past two decades, a better understanding of its etiology and pathogenesis will facilitate the discovery of effective target-specific treatment strategies with a narrow adverse effects profile.

Keywords: : Anti-TNFa, immunosuppression, percutaneous transluminal angioplasty, reconstructive surgery, renal artery stenosis, revascularization, Takayasu's arteritis, vasculitis.