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논문분류	춘계학술대회 초록집
제목	Polyarteritis Nodosa Presenting as Renal Artery Stenosis in a Filipino Female Patient: A Case Report
저자	Stephanie Joyce Liao
출판정보	2024; 2024(1):
키워드
초록	Polyarteritis nodosa (PAN) is a rare multisystem disease characterized by necrotizing vasculitis affecting medium-sized arteries. Incidence is estimated to be in the range of 2-9 per million. In the Philippines, no reliable data on incidence is available. In most cases, hypertension is present when PAN and renal dysfunction occur. Whereas involvement of the renal arterioles and the presence of renal aneurysms is frequently encountered in PAN, involvement of the main renal artery is uncommon. In this report, we present an unusual case of PAN presenting as resistant hypertension and left renal artery stenosis. This is a 35-year-old female who presented with back pain, headache, hypertension, and hypokalemia. Her blood pressure would range between 140-180/80-100 mmHg despite being maintained on three antihypertensives. Her potassium levels were in the range of 2.5-3 meq/L. The initial impression was secondary hypertension, probably secondary to fibromuscular dysplasia. Biphasic CT angiography of the abdomen was done, which revealed atrophy of the left kidney. The left renal artery shows a narrowing segment in the distal portion with thickened vascular walls and significant stenosis of more than 50%. The narrowing of the ileal and jejunal branches of the superior mesenteric artery, which were compatible with vasculitis, was also noted. Physical examination was normal. Additional laboratory findings included an elevated ESR, CRP, normal C3, nonreactive hepatitis panel, and negative results for ANA and ANCA. Renal function was normal. PAN was highly considered due to the constitutional symptoms and presence of renal and mesenteric angiographic changes. Treatment with intravenous methylprednisolone and cyclophosphamide was started. Steroids were tapered, and blood pressure was controlled with no recurrence of hypokalemia. Renal angiographic signs in PAN vary from aneurysms to perfusion defects of renal arteries. CT angiography is a non-invasive and valuable tool in supporting these vascular alterations and confirming the cause of hypertension.
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