Nephrotic syndrome and Giant cell arthritis concurrently occurring after percutaneous transluminal angioplasty for renal artery stenosis .

An elderly Japanese woman with bilateral renal artery occlusion who developed massive proteinuria after unilateral percutaneous transluminal renal angioplasty (PTRA) is reported. She had a history of percutaneous coronary intervention and subsequently developed refractory hypertension. She was diagnosed with renovascular hypertension caused by bilateral total occlusion of the renal arteries, and underwent PTRA for the left renal artery. Nephrotic-range proteinuria from the left kidney, confirmed by split urine collection from each kidney under cytoscopic examination, and low-grade fever with positive C-reactive protein became obvious after PTRA. Giant cell arteritis (GCA) was also diagnosed by positive findings on fluorodeoxyglucose-positron emission tomography in the common carotid arteries, subclavian arteries, and aorta, but not in the renal arteries. Administration of corticosteroid and angiotensin-converting enzyme inhibitor decreased the proteinuria (> 9 - 2 g/day). Possible mechanisms for the development of nephrotic-range proteinuria and a hypothesis that GCA became obvious after PTRA are discussed. .