Seokchan Hong1,2, Byeongzu Ghang1,2, Yong-Gil Kim1,2, Chang-Keun Lee1,2, Bin Yoo3,4. 1. From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 2. S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Ghang, MD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; C.K. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center. 3. From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. byoo@amc.seoul.kr. 4. S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Ghang, MD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; C.K. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center. byoo@amc.seoul.kr.
Abstract
OBJECTIVE: Takayasu arteritis (TA) involving the renal artery can result in hypertension (HTN), renal dysfunction, and premature death. The aim of this study was to investigate the longterm outcomes and factors that predict outcomes in patients with TA with renal artery stenosis. METHODS: The medical records of patients diagnosed with TA between January 1997 and December 2014 were reviewed retrospectively. Renal artery involvement was based on computed tomography and/or angiography findings. Poor outcome was defined as refractory HTN, chronic renal insufficiency, or death. RESULTS: Of the 62 TA patients with renal artery involvement, 11 (17.7%) underwent renal artery revascularization. Younger age, male sex, and more severe stenosis (> 70%) were associated with vascular intervention. After a median followup of 90.6 months, 11 (17.7%) of the 62 patients had refractory HTN and 6 (9.7%) had chronic renal insufficiency. Renal insufficiency [5/15 (33.3%) vs 3/47 (6.4%), p = 0.016] and bilateral involvement [12/15 (80.0%) vs 23/47 (48.9%), p = 0.041] were significantly more frequent in patients with poor than good outcomes. Multivariate Cox analysis revealed that renal insufficiency at presentation (HR 13.778, 95% CI 3.530-53.786, p < 0.001) and bilateral renal artery involvement (HR 5.053, 95% CI 1.179-21.661, p = 0.029) were significant risk factors for poor outcomes at followup, but performance of revascularization procedure was not (HR 0.663, 95% CI 0.176-2.498, p = 0.543). CONCLUSION: Bilateral lesions and renal functional impairment at presentation, but not implementation of revascularization procedures, were significant factors for outcomes in TA patients with renal artery involvement.
OBJECTIVE:Takayasu arteritis (TA) involving the renal artery can result in hypertension (HTN), renal dysfunction, and premature death. The aim of this study was to investigate the longterm outcomes and factors that predict outcomes in patients with TA with renal artery stenosis. METHODS: The medical records of patients diagnosed with TA between January 1997 and December 2014 were reviewed retrospectively. Renal artery involvement was based on computed tomography and/or angiography findings. Poor outcome was defined as refractory HTN, chronic renal insufficiency, or death. RESULTS: Of the 62 TA patients with renal artery involvement, 11 (17.7%) underwent renal artery revascularization. Younger age, male sex, and more severe stenosis (> 70%) were associated with vascular intervention. After a median followup of 90.6 months, 11 (17.7%) of the 62 patients had refractory HTN and 6 (9.7%) had chronic renal insufficiency. Renal insufficiency [5/15 (33.3%) vs 3/47 (6.4%), p = 0.016] and bilateral involvement [12/15 (80.0%) vs 23/47 (48.9%), p = 0.041] were significantly more frequent in patients with poor than good outcomes. Multivariate Cox analysis revealed that renal insufficiency at presentation (HR 13.778, 95% CI 3.530-53.786, p < 0.001) and bilateral renal artery involvement (HR 5.053, 95% CI 1.179-21.661, p = 0.029) were significant risk factors for poor outcomes at followup, but performance of revascularization procedure was not (HR 0.663, 95% CI 0.176-2.498, p = 0.543). CONCLUSION: Bilateral lesions and renal functional impairment at presentation, but not implementation of revascularization procedures, were significant factors for outcomes in TA patients with renal artery involvement.
Authors: Ana F Águeda; Sara Monti; Raashid Ahmed Luqmani; Frank Buttgereit; Maria Cid; Bhaskar Dasgupta; Christian Dejaco; Alfred Mahr; Cristina Ponte; Carlo Salvarani; Wolfgang Schmidt; Bernhard Hellmich Journal: RMD Open Date: 2019-09-23