Clinical rheumatology · 2026
Localized renal artery vasculopathy: avoiding misdiagnosis between inflammatory arteritis and isolated renal artery dissection.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Secka Sopie, Calciolari Ilaria, Maranini Beatrice, Massara Alfonso, Lo Monaco Andrea, Furicchia Filippo, Ferrante Zairo, Acciarri Pierfilippo, Cosacco Alessio Mario, Fargion Aaron Thomas, Govoni Marcello
Аннотация
BACKGROUND: Isolated renal artery involvement, whether inflammatory or dissecting, is an uncommon and challenging presentation in clinical practice. Its nonspecific symptoms and overlap with non-inflammatory vasculopathies complicate the distinction between localized vasculitis and isolated renal artery dissection (IRAD), two entities requiring fundamentally different therapeutic approaches.
CASE PRESENTATION: We report two cases of unilateral renal artery pathology initially suspected to represent vasculitis. Case 1: A 47-year-old man presented with acute flank pain. CT and MRA revealed perivascular tissue surrounding the left renal artery, a small pseudoaneurysm, and patchy hypoperfusion. Serology, inflammatory markers, and PET/CT excluded systemic vasculitis. Corticosteroid therapy led to complete radiologic resolution, consistent with a localized idiopathic fibro-inflammatory arteritis. Case 2: A 42-year-old patient developed abrupt-onset hypertension and renal ischemia. Initial imaging suggested "sleeve-like" arterial thickening, raising concern for vasculitis. Selective angiography subsequently confirmed spontaneous renal artery dissection with thrombotic involvement of a segmental branch. The patient was managed conservatively with antihypertensives and antiplatelet therapy, achieving clinical stability and partial perfusion recovery.
DISCUSSION: These cases illustrate the diagnostic complexity of isolated renal artery disease. Normal or only mildly elevated inflammatory markers do not reliably exclude localized vascular inflammation. Advanced cross-sectional imaging and timely angiography are essential when diagnostic uncertainty persists. Misinterpretation may result in unnecessary immunosuppression or failure to recognize IRAD.
CONCLUSION: A structured, multidisciplinary evaluation integrating serologic assessment, high-resolution imaging, and close follow-up is crucial for accurate diagnosis. While isolated vasculitis may require immunosuppression, IRAD typically responds to conservative therapy, underscoring the need for individualized management.
CASE PRESENTATION: We report two cases of unilateral renal artery pathology initially suspected to represent vasculitis. Case 1: A 47-year-old man presented with acute flank pain. CT and MRA revealed perivascular tissue surrounding the left renal artery, a small pseudoaneurysm, and patchy hypoperfusion. Serology, inflammatory markers, and PET/CT excluded systemic vasculitis. Corticosteroid therapy led to complete radiologic resolution, consistent with a localized idiopathic fibro-inflammatory arteritis. Case 2: A 42-year-old patient developed abrupt-onset hypertension and renal ischemia. Initial imaging suggested "sleeve-like" arterial thickening, raising concern for vasculitis. Selective angiography subsequently confirmed spontaneous renal artery dissection with thrombotic involvement of a segmental branch. The patient was managed conservatively with antihypertensives and antiplatelet therapy, achieving clinical stability and partial perfusion recovery.
DISCUSSION: These cases illustrate the diagnostic complexity of isolated renal artery disease. Normal or only mildly elevated inflammatory markers do not reliably exclude localized vascular inflammation. Advanced cross-sectional imaging and timely angiography are essential when diagnostic uncertainty persists. Misinterpretation may result in unnecessary immunosuppression or failure to recognize IRAD.
CONCLUSION: A structured, multidisciplinary evaluation integrating serologic assessment, high-resolution imaging, and close follow-up is crucial for accurate diagnosis. While isolated vasculitis may require immunosuppression, IRAD typically responds to conservative therapy, underscoring the need for individualized management.