Prevalence and risk factors of chronic kidney disease in Takayasu arteritis

Bulanov N.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

Logina V.: Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia

Efimova A.A.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow

Vlasova N.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University

Makarova K.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University

Skvortsov A.: Moscow State University, Moscow

Suvorov A.: Center for Analysis of Complex Systems, Sechenov First Moscow State Medical University, Moscow

Novikov P.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

Moiseev S.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

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Summary

Takayasu arteritis (TA) is a rare systemic vasculitis affecting aorta and its branches. Glomerulonephritis and tubulointerstitial nephritis are not typical for TA. However progressive kidney dysfunction can result from renal artery involvement or refractory hypertension.

Aim

To assess the prevalence of chronic kidney disease (CKD) and associated risk factors among patients with TA.

Material and methods

In a single-center retrospective study, we enrolled adult (≥18 years old) patients with TA diagnosed in accordance with the American College of Rheumatology classification criteria (1990 and/or 2022) and/or Chapel Hill Consensus Conference (2012) definition. The cases that did not contain data sufficient to assess kidney involvement were excluded. CKD was diagnosed according to the KDIGO 2012 and Russian Association of Nephrologists definitions. The data on patients’ demographics, disease course, renal artery involvement, kidney function, blood pressure, cholesterol levels were extracted from medical documentation.

Results

We studied 152 patients with TA, 143 females and 9 males, mean age at disease onset 28,8±10,4 years. Median duration of follow up was 4 (1-10) years. Ninety-four (61,8%) patients had hypertension, 67 (44.1%) had hypercholesterolemia, and 5 (3.3%) had diabetes mellitus. Renal artery involvement was reported in 45 (29.6%) patients, including bilateral involvement in 15 (9.9%). At the end of follow up, 14 (9.2%) patients had estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2, among them one patient required renal replacement therapy. Sixty-eight (44.7%) patients had eGFR between 60 and 89.9 mL/min/1.73 m2. Persistent proteinuria was present in 11 (7.2%) of patients. CKD was diagnosed in 22 (14.5%) patients. Multivariate linear regression showed that eGFR at the end of follow up was significantly associated with the age at disease onset (p=0.008), bilateral kidney artery stenosis (p=0.021), and hypercholesterolemia (p=0.022), however these factors explained only 18.2% of the eGFR variance. Kidney biopsy was performed in four patients due to a rapid increase in the serum creatinine level and/or proteinuria and revealed AA-amyloidosis, immune-complex mesangioproliferative glomerulonephritis, secondary focal segmental glomerulosclerosis, and granulomatous interstitial nephritis.

Conclusion

High prevalence of CKD and both diseasespecific and traditional risk factors in patients with TA emphasizes the importance of monitoring and timely initiation of nephroprotective therapy.

Key words

Takayasu arteritis, chronic kidney disease, renal artery stenosis, hypercholesterolemia.