nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2020-1-108-130nid-200Research ArticleШКОЛА НЕФРОЛОГАEDUCATIONAL MATERIALSТрудности диагностики системных васкулитов с вовлечением средних и крупных сосудов и поражением почек: обзор литературы и описание трех случаевDiagnostics of kidney damage in the medium and large vessels vasculitis - review and presentation of three casesЗахароваЕ. В.ZakharovaE. V.helena.zakharova@gmail.comМакароваТ. А.MakarovaT. A.noemail@neicon.ruЛеоноваЕ. С.LeonovaE. S.noemail@neicon.ruСтоляревичЕ. С.StolyarevichE. S.noemail@neicon.ruВоробьеваО. А.VorobyovaO. A.noemail@neicon.ruГБУЗ «Городская клиническая больница имени С.П. Боткина» ДЗ г. Москвы; ГБОУ ВПО Российская медицинская академия непрерывного профессионального образования; ГБОУ Московский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияS.P. Botkin City Hospital; Russian Medical Academy of Postgraduate Education; A.I. Evdokimov Moscow State University of Medicine and Dentistry, MoscowRussian FederationГБУЗ «Городская клиническая больница имени С.П. Боткина» ДЗ г. МосквыРоссияS.P. Botkin City HospitalRussian FederationГБОУ Московский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry, MoscowRussian FederationНациональный Центр Клинической Морфологической ДиагностикиРоссияNational Centre for Clinical Morphological DiagnosticsRussian Federation202026072024221108130Copyright © Захарова Е.В., Макарова Т.А., Леонова Е.С., Столяревич Е.С., Воробьева О.А., 20242024Захарова Е.В., Макарова Т.А., Леонова Е.С., Столяревич Е.С., Воробьева О.А.Zakharova E.V., Makarova T.A., Leonova E.S., Stolyarevich E.S., Vorobyova O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/200

Согласительная конференция по пересмотру номенклатуры васкулитов 2012 относит к группе васкулитов с вовлечением сосудов среднего калибра узелковый полиартериит и болезнь Кавасаки, а к группе васкулитов с вовлечением сосудов крупного калибра - артериит Такаясу и гигантоклеточный артериит. Узелковый полиартериит представляет собой некротизирующий васкулит с поражением артерий мелкого и среднего калибра. Вовлечение почек при узелковом полиартериите отмечается в 50-60% случаев, характеризуется развитием множественных инфарктов почек и формированием аневризм внутрипочечных артерий, что ведет к ишемии коры почек и клинически проявляется преимущественно развитием артериальной гипертензии и нарушением почечной функции при относительно скудном мочевом синдроме. Внепочечная симптоматика узелкового полиартериита многообразна и включает поражения различные варианты кожи, мышц, суставов, нервной системы, желудочно-кишечного тракта и сердца. Артериит Такаясу представляет собой васкулит, часто гранулематозный, поражающий артерии крупного калибра - преимущественно аорту и ее крупные ветви. Более чем в половине случаев у пациентов с артериитом Такаясу в результате сужения одной или обеих почечных артерий и/или аорты развивается артериальная гипертензия, в ряде случаев тяжелая. Помимо гипертензии, при артериите Такаясу наблюдается также поражение мышц, суставов, кожи, сердца, желудочно-кишечного тракта, дыхательной и нервной системы, обусловленное ишемией. Мы представляем обзор литературы по диагностике и лечению узелкового полиартериита и артериита Такаясу, иллюстрированный описанием двух случаев узелкового полиартериита и одного случая артериита Такаясу с необычными вариантами поражения почек - аневризма магистральной почечной артерии и псевдотуморы почек при узелковом полиартериите, и вторичный фокальный сегментарный гломерулосклероз при артериите Такаясу, которые демонстрируют трудности диагностики и эффективность иммуносупрессивной терапии при этих редких заболеваниях. Во всех трех случаях наблюдалась артериальная гипертензия, умеренное обратимое нарушение функции почек и множественные системные проявления, которые мы подробно обсуждаем в комментариях.

2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides defines polyarteritis nodosa as a medium vessels vasculitis - a necrotizing arteritis of medium or small arteries, and Takayasu arteritis as large vessel vasculitis, often granulomatous, affecting aorta and its primary branches. Polyarteritis nodosa typically affects skin, joints, peripheral nervous system, digestive tract and kidneys. Kidney involvement, observed in up to 60% of cases, includes multiple infarctions, aneurisms formation and glomerular ischemia, clinically presenting mostly with arterial hypertension and decline of kidney function; proteinuria usually absent or mild, but if present - is a hallmark of worse outcome. Takayasu arteritis in more than 50% of cases presents with arterial hypertension due to the narrowing or occlusion of renal arteries and/or aorta, accompanied by the clinical features of skin, joints, muscles, heart, digestive tract and nervous system ischemic damage. Here we present a literature review, including diagnostic criteria and other common features, differential diagnostics, and treatment of polyarteritis nodosa and Takayasu arteritis. We illustrate the review with three cases, two of polyarteritis nodosa and one of Takayasu arteritis with unusual and severe kidney damage - main renal artery aneurism and kidney pseudotumors in polyarteritis nodosa, and secondary focal segmental glomerulosclerosis in Takayasu arteritis, demonstrating diagnostic difficulties and efficacy of immunosuppressive treatment in these rare conditions. All three patients presented with arterial hypertension, reversible decline of kidney function, and multiple systemic signs and symptoms, which we discuss in details in our comments. We also discuss pathology findings; kidney histology study performed after nephrectomy in both cases of polyarteritis nodosa, in the case of Takayasu arteritis kidney biopsy was available.

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The authors declare that there are no conflicts of interest present.