Renal transplantation in a patient with polyarteritis nodosa - A case report

Abstract

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis, predominantly affecting medium-sized arteries, and usually involving the kidneys, heart, gastrointestinal tract, and nervous system. The common clinical presentation is renovascular hypertension due to renal artery stenosis. We report a 38-year-old man, who presented with secondary hypertension and progressive renal failure leading on to end-stage renal disease (ESRD). He had renal artery stenosis on evaluation which caused ischemic damage to the kidneys resulting in ESRD. He also had multivessel coronary artery disease requiring percutaneous transluminal angioplasty. Coronary angiogram and renal angiogram showed areas of ectatic segments and aneurysms along with stenotic segments, which was consistent with medium-vessel vasculitis. We had challenges in considering him for kidney transplantation due to significant coronary artery disease, and he required coronary angioplasty on two occasions 6 months apart. He underwent bilateral nephrectomy prior to the transplantation as he had refractory hypertension requiring five antihypertensive medications. Histology of the nephrectomy specimen confirmed the diagnosis of PAN. Our patient did not show evidence of hepatitis B infection which is commonly associated with PAN. Renal failure and progression to ESRD are rare in PAN and are due to ischemic damage to the kidneys. He underwent kidney transplantation and had a smooth perioperative period and normal graft functions 6 months after the transplant surgery. To the best of our knowledge, this is the second reported case of PAN, who underwent successful kidney transplantation. Significant coronary artery disease is a rare manifestation in PAN.

Keywords

• coronary artery disease
• end-stage renal disease
• polyarteritis nodosa
• renal transplantation
• vasculitis