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NDT Advance Access originally published online on September 8, 2006
Nephrology Dialysis Transplantation 2007 22(1):276-277; doi:10.1093/ndt/gfl513
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
(Section Editor: G. H. Neild)

Bilateral renal aneurysms in a chronic hepatitis B patient

Wen-Hung Huang1, Li-Jen Wang2,3, Chun-Cheng Yu1,3 and Ja-Liang Lin1,3

1Department of Nephrology and 2Department of Radiology, Chang Gung Memorial Hospital and 3School of Medicine, Chang Gung University, Taipei, Taiwan

Correspondence and offprint requests to: Chun-Cheng Yu, Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, 199, Tun-Hwa North Road, Taipei, 105, Taiwan. Email: mireda{at}adm.cgmh.org.tw

Keywords: aneurysm; angiograph; computerized tomographic angiography; hepatitis B; PAN; polyarteritis nodosa

We describe a 41-year-old female with a medical history of chronic hepatitis B. She was not hypertensive. Following right lower back pain, the patient consulted at a local clinic. Right renal aneurysms were detected by renal echo and computerized tomography (CT), and she was referred to us. Computerized tomographic angiography showed multiple aneurysms in both kidneys resembling aneurysms of polyarteritis nodosa (PAN); the largest is about 3 cm in diameter near the hilar region of right kidney (Figure 1). Immunology reports were all negative as shown subsequently: antineutrophil cytoplasmic antibodies (ANCAs), antimyeloperoxidase antibodies (antiMPO), antinuclear antibody and rheumatoid factor. Hepatitis B surface antigen was positive with negative hepatitis C antibodies. Trans-arterial angiography (Figure 2) was arranged and embolization of the largest aneurysm was performed successfully. The patient remains well with normal function.


Figure 1
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  		Fig. 1. Computerized tomographic angiography shows multiple aneurysms in both kidneys. The largest is about 3 cm in diameter in the right kidney.

 

Figure 2
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  		Fig. 2. Renal arterial angiography shows multiple micro- and macro-aneurysms in both kidneys. Note the right accessory renal artery in the angiography (arrow).

 
Discussion

Multiple renal aneurysms are very rare. Due to the extensive use of angiography, renal aneurysms are now diagnosed more frequently [1]. In pregnant patients, the incidence of aneurysm rupture is high [2]. Microaneurysms are commonly present in polyarteritis nodosa, predominantly seen in the kidneys, mesentery and liver [3]. Renal or perirenal haematomas may result from the ruptum of microaneurysms. The indications for treatment of a renal artery aneurysm are the presence of intra-aneurysmal clots, hypertension and potential for rupture [2].

Conflict of interest statement. None declared.

References

  1. Bulbul MA and Farrow GA. (1992) Renal artery aneurysms. Urology 40:124–126.[CrossRef][Web of Science][Medline]
  2. Scoble JE. (2003) Renal vascular thrombosis and occlusion. In Johnson RJ and Fehally J (Eds.). Comprehensive Clinical Nephrology(Mosby, London, UK) pp. 827.
  3. Lhote F, Cohen P, Guillevin L. (1998) Polyarteritis nodosa, microscopic polyangitis and Churg-Strauss syndrome. Lupus 7:238–258.[Abstract/Free Full Text]
Received for publication: 18. 7.06
Accepted in revised form: 4. 8.06


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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
22/1/276    most recent
gfl513v1
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