J Rheum Dis.  2018 Oct;25(4):296-301. 10.4078/jrd.2018.25.4.296.

Case of Renal Microaneurysms and Multiple Renal Infarctions in a Patient with Systemic Lupus Erythematosus

• Kang JW
• Lee ES
• Eun JS
• Kim NR
• Han SW
• Lee SJ
• Kang YM
• Han MH
• Nam EJ

• KMID: 2429714
• DOI: http://doi.org/10.4078/jrd.2018.25.4.296

Abstract

Systemic lupus erythematosus (SLE) is a chronic inflammatory, heterogeneous autoimmune disease characterized by autoantibody production and the potential involvement of almost every organ system. Although vasculitis usually confined to small vessels is a fairly common feature of SLE, ischemic vasculitis with an aneurysm is an uncommon feature. In particular, renal arterial microaneurysms and multiple renal infarctions are very rarely reported in patients with SLE. Furthermore, to the best of the authors' knowledge, there is no report on renal arterial microaneurysms associated with SLE in Korea. Here, this paper presents a case of renal microaneurysms and multiple renal infarctions in a 41-year-old woman with SLE.

Keyword

Systemic lupus erythematosus; Renal microaneurysm; Renal infarction

MeSH Terms

Adult
Aneurysm
Autoimmune Diseases
Female
Humans
Infarction*
Korea
Lupus Erythematosus, Systemic*
Vasculitis

Figure

• 

  Figure 1 (A) Any abnormal lesions, such as lung nodule, parenchymal infiltration or cavities were not found on chest X-ray. (B) Water's view showed no abnormal haziness or opacification of the maxillary sinus. (C) Bone scan demonstrated an increase in uptake of the first to fifth metatarsophalangeal joints on left foot (arrows). (D) Foot X-ray did not reveal any erosions on metatarsophalangeal joints of both feet.

• 

  Figure 2 (A) Abdominal computed tomography (CT) revealed multiple wedge-shaped, sharply marginated, low-density lesions (arrowheads) in the both kidney parenchyma, which are consisted with the findings of renal infarctions. (B) After ten months of therapy, follow-up abdominal CT showed improved lesions in the both renal parenchyma.

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  Figure 3 (A) Renal angiograpy showed multiple saccular microaneurysms in the peripheral segments of the right and left renal arteries. (B) After ten months of therapy, follow-up renal angiography showed a significantly reduced number of microaneurysms.

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  Figure 4 Histopathologic analysis of kidney demonstrated well-demarcated atrophic change and scar formation with prominent peritubular inflammatory cell infiltrations. However, there were no evidences of a fibrinoid necrosis of vascular beds or active glomerular lesions (H&E, A: ×40, B: ×100).

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