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RENOVASCULAR VASCULAR DISEASES

  • UNDERGRADUATE LECTURE

ISTIFANUS BALA BOSAN

PROFESSOR OF MEDICINE/NEEPHROLOGY

AHMADU BELLO UNIVERSITY, ZARIA

FEBRUARY 2022

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INTRODUCTION

  • The Kidney has a large number and variety of blood vessels

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  • Vasculitis involving the Kidneys can produce a wide variety of clinical manifestations

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  • These depend on whether small vessels, medium sized vessels or large vessels

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Small vessel disease

  • Small vessel vasculitis target the kidneys causing necrotizing polyangiitis

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  • Affect predominantly arterioles, capillaries, venules and some small arteries.

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  • Commonly present as glomerulonephritis

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  • Could be pauci-immune or immune mediated

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Small vessel pauci-immune vasculitis

  • Wegener’s granulomatosis
    • Necrotizing granulomatous inflammation

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  • Churg-Strauss Syndrome
    • Occurs associated with Asthma, Eiosinophilia necrotizing granulomatous inflammation

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  • Microscopic polyangiitis
    • systemic disease without asthma, eiosinophilia and no necrotizing granulomatous inflammation

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  • All the pauci-immune diseases are characterized by necrosis and crescent formation but no immune deposits.

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  • Associated with positive ANCA

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  • Henoch-Schonlein vasculitis
    • A small vessel disease with
    • Diffuse IgA immune deposits
    • Messangeal proliferative GN
    • Associated with infections – mycoplasma, yersinia, haemophilus, adenoviruses, EBV, Coxsackie
    • Treatment include tonsilectomy, dietary gluten restriction, steroids and cytotoxic drugs.
    • ACE inhibitors to control BP

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  • Essential cryoglobulinaemic vasculitis

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  • Cutaneous leucocytoclastic angiitis

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Medium sized vessel vasculitis

  • Polyarteritis nodosa
    • Necrotizing inflammation in the medium and small sized arteries but not arterioles and venules
    • Vascular hypertension

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  • Kawasaki disease
    • Inflammation of large, medium and small vessels with muco-cutaneous lymph node syndrome. Coronary artery and Aorta may be involved

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Large vessels vasculitis

  • Giant cell (temporal) arteritis
    • Affect the Aorta and its main branches, carotid and temporal arteries
    • >50 years, polymyalgia.

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  • Takayasu arteritis
    • Granulomatous inflammation of the Aorta and main branches in <50 years.

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  • Renal artery stenosis
    • From arterosclerosis - hyperlipidaemia
    • Arterionephrosclerosis – aging
    • Artheroemboli and renal artery/vein thrombosis

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Summary