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Bilateral renal subcapsular hematoma caused by polyarteritis nodosa: a case report

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Abstract

Polyarteritis nodosa, which is a systemic vasculitis of small- and medium-sized arteries, can cause arterial aneurysms in various organs, sometimes resulting in aneurysm rupture and hemorrhage. A kidney is one of the major targets of polyarteritis nodosa. Here, we report a 73-year-old woman who presented with sudden-onset high fever, diarrhea, and renal injury with bilateral renal subcapsular hematoma shown on contrast-enhanced computed tomography scan. She did not have trauma and significant medical history other than breast cancer in remission. Serological and immunological tests except for anti-Sjögren's syndrome-A and anti-Sjögren's syndrome-B were all negative. Digital subtraction angiography revealed bilateral intrarenal micro aneurysms, which allowed us to diagnose the patient with polyarteritis nodosa. As continuous monitoring of bilateral intrarenal hematoma by ultrasonography and computed tomography scan did not detect progression of intrarenal hemorrhage and extra renal hematoma, transcatheter arterial embolization and nephrectomy were not performed. Although hemodialysis therapy was required temporarily for acute kidney injury with anuria, her general condition and kidney function remarkably improved after receiving systemic immunosuppressive therapy with corticosteroids and cyclophosphamide. In conclusion, this is a rare case of polyarteritis nodosa manifesting as spontaneous bilateral subcapsular renal hemorrhage with deteriorated renal function, which was successfully treated with immunosuppressive therapy.

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Abbreviations

PAN:

Polyarteritis nodosa

CT:

Computed tomography

BUN:

Blood urea nitrogen

Cr:

Creatinine

FENa:

Fraction excretion of sodium

TAE:

Trans catheter arterial embolization

DSA:

Digital subtraction angiography

PSL:

Prednisolone

ADPKD:

Autosomal dominant polycystic kidney disease

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan

    Yui Kambayashi, Ken Iseri, Yasutaka Yamamoto, Maki Abe, Yukihiro Wada & Hirokazu Honda

  2. Department of Medicine, Division of Rheumatology, Showa University School of Medicine, Tokyo, Japan

    Ryo Yanai

Authors
  1. Yui Kambayashi
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  2. Ken Iseri
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  3. Yasutaka Yamamoto
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  4. Maki Abe
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  5. Yukihiro Wada
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  6. Ryo Yanai
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  7. Hirokazu Honda
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Contributions

YK reviewed the patient’s clinical data. YK and KI wrote the initial draft of the manuscript. YK, KI, YY, MA, YW, RY, and HH treated the patient, contributed to writing the manuscript, and revised the final version of the manuscript. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Yui Kambayashi.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.

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Kambayashi, Y., Iseri, K., Yamamoto, Y. et al. Bilateral renal subcapsular hematoma caused by polyarteritis nodosa: a case report. CEN Case Rep 11, 399–403 (2022). https://doi.org/10.1007/s13730-022-00691-5

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  • DOI: https://doi.org/10.1007/s13730-022-00691-5

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