![](/images/graphics-bg.png)
A Case of Rheumatoid Arthritis Presenting with Renal Thrombotic Microangiopathy Probably due to a Combination of Chronic Tacrolimus Arteriolopathy and Severe Hypertension
Joint Authors
Arai, Shigeyuki
Tamura, Yoshifuru
Nemoto, Yoshikazu
Nagura, Michito
Uchida, Shunya
Shibata, Shigeru
Honma, Fumika
Kikuchi, Hirotoshi
Ishizawa, Kenichi
Fujigaki, Yoshihide
Kondo, Fukuo
Yamazaki, Osamu
Ohashi, Ryuji
Source
Issue
Vol. 2019, Issue 2019 (31 Dec. 2019), pp.1-7, 7 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2019-03-06
Country of Publication
Egypt
No. of Pages
7
Main Subjects
Abstract EN
A 51-year-old woman with rheumatoid arthritis presented with mild hypertension 20 months after tacrolimus treatment and developing proteinuria 24 months after the treatment.
Tacrolimus was discontinued 27 months after the treatment, followed by heavy proteinuria, accelerated hypertension, and deteriorating renal function without ocular fundus lesions as a clinical sign of malignant hypertension.
Renal biopsy revealed malignant nephrosclerosis characterized by subacute and chronic thrombotic microangiopathy (TMA), involving small arteries, arterioles, and glomeruli.
Focal segmental glomerulosclerosis, probably secondary to chronic TMA, was identified as a cause of heavy proteinuria.
The zonal tubulointerstitial injury caused by subacute TMA may have mainly contributed to deteriorating renal function.
The presence of nodular hyalinosis in arteriolar walls was indicative of tacrolimus-associated nephrotoxicity.
Together with other antihypertensive drugs, administration of aliskiren stabilized renal function with reducing proteinuria.
Owing to the preexisting proteinuria prior to severe hypertension and the complex renal histopathology, we postulated that chronic TMA, which was initially triggered by tacrolimus, was aggravated by severe hypertension, resulting in overt renal TMA.
American Psychological Association (APA)
Honma, Fumika& Fujigaki, Yoshihide& Nemoto, Yoshikazu& Kikuchi, Hirotoshi& Nagura, Michito& Arai, Shigeyuki…[et al.]. 2019. A Case of Rheumatoid Arthritis Presenting with Renal Thrombotic Microangiopathy Probably due to a Combination of Chronic Tacrolimus Arteriolopathy and Severe Hypertension. Case Reports in Nephrology،Vol. 2019, no. 2019, pp.1-7.
https://search.emarefa.net/detail/BIM-1141102
Modern Language Association (MLA)
Honma, Fumika…[et al.]. A Case of Rheumatoid Arthritis Presenting with Renal Thrombotic Microangiopathy Probably due to a Combination of Chronic Tacrolimus Arteriolopathy and Severe Hypertension. Case Reports in Nephrology No. 2019 (2019), pp.1-7.
https://search.emarefa.net/detail/BIM-1141102
American Medical Association (AMA)
Honma, Fumika& Fujigaki, Yoshihide& Nemoto, Yoshikazu& Kikuchi, Hirotoshi& Nagura, Michito& Arai, Shigeyuki…[et al.]. A Case of Rheumatoid Arthritis Presenting with Renal Thrombotic Microangiopathy Probably due to a Combination of Chronic Tacrolimus Arteriolopathy and Severe Hypertension. Case Reports in Nephrology. 2019. Vol. 2019, no. 2019, pp.1-7.
https://search.emarefa.net/detail/BIM-1141102
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1141102