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Diagnosis: Polyarteritis Nodosa

Polyarteritis nodosa (PAN) is a systemic vasculitis characterized by necrotizing inflammatory lesions that affect medium-sized and small muscular arteries, preferentially at vessel bifurcations, resulting in microaneurysm formation, aneurysmal rupture with hemorrhage, thrombosis, and, organ ischemia or infarction. As lesions progress, proliferation of the intima or media may result in obstruction and subsequent tissue ischemia or infarction. Polyarteritis nodosa spares large and smallest vessels (capillaries and small arterioles), and the venous system. (Jacobs-Kosmin D. Polyarteritis nodosa. In eMedicine (consulted: Jan 16th, 2015): [Link]).

Renal involvement frequently leads to variable degrees of renal insufficiency and hypertension. Multiple renal infarctions may develop in those with severe vasculitis. Incomplete luminal narrowing of the inflamed arteries leads to glomerular ischemia . Thus, the urinalysis, when abnormal, shows only sub-nephrotic and often minimal proteinuria and perhaps modest hematuria. (Merkel PA. Clinical manifestations and diagnosis of polyarteritis nodosa in adults. In UpToDate (consulted: Feb 23th, 2015): [Link]).

See the chapter: Vascular Diseases of our Tutorial.

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References

• Forbess L, Bannykh S. Polyarteritis nodosa. Rheum Dis Clin North Am. 2015;41(1):33-46. [PubMed link]
• Jacobs-Kosmin D. Polyarteritis nodosa. In eMedicine (consulted: Jan 16th, 2015): [Link]
• Hernández-Rodríguez J, Alba MA, Prieto-González S, Cid MC. Diagnosis and classification of polyarteritis nodosa. J Autoimmun. 2014;48-49:84-9. [PubMed link]
• van Kuijk JP, Geers T. Classic polyarteritis nodosa. Clin Exp Nephrol. 2013;17(4):590-1. [PubMed link]

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