Images in Clinical Medicine
Kim Eagle, M.D., Editor
Renal Aneurysms in Hepatitis B–Associated Polyarteritis Nodosa
N Engl J Med 1995; 332:1070April 20, 1995
- Article
Figure 1 Abdominal arteriography was performed in a 21-year-old drug abuser who presented with rapidly progressive renal failure. During the previous two months she had had fever and diffuse abdominal pain and had lost 12 kg in weight. The recent onset of hypertension (blood pressure, 150/120 mm Hg) and cardiac failure was also noted. Tests for hepatitis B surface antigen, hepatitis B virus DNA, and hepatitis C virus antibody were positive, but a test for human immunodeficiency virus antibody was negative. Selective arteriography of the right kidney (Panel A) revealed multiple aneurysms with vessel narrowing and irregularity in medium-sized arteries. The parenchymatous phase (Panel B) revealed large cortical ischemic areas caused by arterial thrombosis. The patient was treated with corticosteroids, plasma exchange, and interferon alfa. Renal failure persisted, and regular hemodialysis was required. Ten weeks later, a second arteriogram showed only a few microaneurysms (Panel C). Tests for hepatitis B surface antigen and hepatitis B virus DNA were still positive. After 16 weeks of hemodialysis, renal function began to improve. Five months after dialysis was discontinued, the patient's serum creatinine concentration was 1.6 mg per deciliter (140 μmol per liter).
Kim Eagle, M.D.
Dominique Chauveau, M.D.
Jean-Louis Christophe, M.D.
Hôpital Necker, 75015 Paris, France
