LAUSR

A 57-year-old lady with a history of diabetes mellitus was admitted in our clinic with fatigue and raised ESR (85 mm/ 1st h) and CRP (36 mg/L). Twelve years earlier, a stent had been placed for bilateral stenosis of aortoiliac arteries. One year after that, a CT (computed tomography) scan showed the atrophic left kidney and a CTangiography (CTA) revealed stenosis of both kidney arteries. An endovascular stent was placed in the right kidney artery (RKA). Patient did not seek for any further medical advice until her admission to our hospital. A chest X-ray (CXR) performed in our clinic showed aortic arch and descending aorta stenosis, with post-stenotic dilatation (Fig. 1). Ultrasound (confirmed also by magnetic resonance angiography (MRA)) revealed 75% stenosis of the left common carotid and subclavian artery and total occlusion of the right common carotid and subclavian artery. Additionally, post-stent stenosis of 75% was observed in the RKA. Patient was treated for Takayasu arteritis (TAK) with azathioprine (2mg/kg) and methylprednisolone (30 mg/day) with good response. During steroids tapering, disease relapsed and RKA stenosis advanced to 90%. Infliximab (5 mg/kg) was commenced. Six months later, due to incomplete response, patient was switched to tocilizumab (8 mg/kg), that was continued for 6 years. Eventually, occlusion of the RKA led to initiation of kidney dialysis. She passed away 1 year later due to dialysis complications.