Diagnosis of kidney damage with nodular periarteritis

Instrumental diagnosis of nodular polyarteritis

• The most informative method for diagnosing kidney damage with nodular polyarteritis is angiography.
  • When it is performed, multiple rounded saccular aneurysms of the intrarenal vessels are revealed in almost 70% of patients. In addition to aneurysms, the sites of thrombotic occlusion and stenosis of vessels are determined. Aneurysms are located bilaterally, their number usually exceeds 10, the diameter varies from 1 to 12 mm. Patients with typical aneurysms on angiograms have, as a rule, a heavier arterial hypertension, they have more expressed weight loss and abdominal syndrome, more often they detect HBsAg.
  • Another pathognomonic angiographic feature is the absence of contrasting distal segments of the intrarenal arteries, which creates a characteristic picture of the "scorched wood".
• Carrying out angiography limits the impairment of renal function that exists in most patients with nodular periarteritis, which can be aggravated by the introduction of radiopaque drugs. In this regard, in recent years, the use of ultrasound dopplerography of the renal arteries, but the diagnostic value of this non-invasive method of research compared with angiography needs to be clarified.
• A kidney biopsy of patients with nodular polyarteritis is rarely performed, as it is associated with the danger of bleeding when an aneurysm is traumatized. Indications for the procedure may be limited to severe hypertension.

Laboratory diagnosis of nodular polyarteritis

Laboratory changes in nodular polyarteritis are nonspecific. The most frequently observed increase in ESR, leukocytosis, thrombocytosis. Anemia, as a rule, is noted for chronic kidney failure or gastrointestinal bleeding. In patients with nodular polyarteritis in the blood, dysproteinemia with an increase in the concentration of y-globulins, rheumatoid and antinuclear factors, almost 50% of cases of antibodies to cardiolipin and a decrease in the level of complement in the blood, which correlates with the activity of the disease. Markers of HBV infection in the blood are detected in more than 70% of patients. In the active phase of the disease, as a rule, an increase in the level of circulating immune complexes is recorded.

Differential diagnosis of nodular periarteritis

Diagnosis of nodular polyarteritis does not cause difficulties at the height of the disease, when there is a combination of renal damage with high arterial hypertension with violations of the gastrointestinal tract, heart, peripheral nervous system. Difficulties in diagnosis are possible at early stages before the development of lesions of internal organs and with monosyndromic disease. In the case of polysyndromic disease in patients with fever, myalgia, and severe weight loss, nodular polyarteritis should be excluded, the diagnosis of which can be confirmed morphologically by biopsy of the musculocutaneous flap by detecting signs of necrotizing panvasculitis of medium and small vessels, nevertheless, in connection with the focal character of the process, a positive the result is noted in no more than 50% of patients.

Nodular polyarteritis with renal involvement must be differentiated from a number of diseases.

• Chronic glomerulonephritis of hypertonic type, in contrast to nodular polyarteritis, proceeds more benignly, without signs of systemic damage, fever, weight loss.
• Systemic lupus erythematosus affects mostly young women. The development of abdominal pain syndrome, severe polyneuropathy, coronary artery disease, leukocytosis is not typical. Renal damage is more often manifested by nephrotic syndrome or rapidly progressive glomerulonephritis. Malignant arterial hypertension is not characteristic of systemic lupus erythematosus. Detection of LE cells, antinuclear factor, antibodies to DNA confirm the diagnosis of systemic lupus erythematosus.
• Subacute infective endocarditis is manifested by high fever, leukocytosis, and disproteinemia. For subacute infectious endocarditis is not characterized by severe arterial hypertension, arthritis, expressed by myalgia with muscle atrophy. With echocardiography, vegetation on the valves of the heart, signs of a heart defect are revealed. Critical in the diagnosis of subacute infective endocarditis has a repeated bacteriological study of blood.
• Alcoholic disease can occur with damage to the peripheral nervous system, heart, pancreas (abdominal pain), kidney (persistent hematuria); in most cases, note arterial hypertension. In such patients, the collection of anamnesis (the fact of alcohol abuse, the onset of the disease from an episode of jaundice due to acute alcoholic hepatitis) and examination (identify "small" signs of alcoholic illness - finger tremor, autonomic lability, Dupuytren's contractures) are of particular importance. In a laboratory study, a high concentration of IgA in the blood, characteristic of alcoholic
  illness , is revealed .

[1], [2], [3], [4]