Wikipedia

Necrotizing arteriolitis

Necrotizing arteriolitis, also called necrotizing arteritis is an[2] inflammation of medium-sized blood vessels and arterial walls, also called vasculitis, that leads to tissue necrosis. It presents with symptoms such as fever, inflammation, muscle weakness, abdominal pain[citation needed] and most notably, hypertension.

Necrotizing arteriolitis
Pronunciation
  • nek'rō-tīz-ing ahr-tēr'ē-ō-lī'tis [1]
SpecialtyNephrology
SymptomsNecrosis, numbness, peripheral neuropathy and severe inflammation of the arteries
CausesPolyarteritis nodosa; Granulomatosis with polyangiitis; Lupus erythematosus; Hepatitis C; Autoimmune response
PreventionThere is no known way of preventing the disease.
TreatmentAdministering corticosteroids and immunosuppresive drugs

History

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Kussmaul and Maier gave the first detailed description of systemic necrotizing arteritis in 1866.[3]

In 1919 Karl Theodor Fahr[4] described acute arterial lesions which were always present in malignant nephrosclerosis. These injuries were the most severe and widespread in the kidneys and occurred less frequently and severely in other organs, particularly in the pancreas, adrenals and intestines. Fahr believed that necrotizing arteriolitis was the primary cause of the lesions, malignant necrosis and hypertension in these cases by narrowing the renal vascular bed.[3]

Symptoms

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The symptoms include:

Emergency symptoms

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The organ most damaged by the disease is the kidney. Hypertension is one of the principal symptoms of the disease, as the most damaged by the disease is the kidney. This has been mostly studied by Harry Goldblatt.[3][12]

Causes

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Necrotizing arteriolitis may be the primary condition in patients with polyarteritis nodosa or granulomatosis with polyangiitis. It could also be a result of another disorder, such as lupus erythematosus or hepatitis C. What causes the inflammation is not known, but is likely related to the autoimmune response.[9][failed verification]

The intestinal version of the disease may be a reaction in collagen disease.[13]

Treatment

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In most cases, corticosteroids are administered. For severe cases, Cytoxan used to be administered, but is being fased out in favor of Rituxan, a less toxic alternative. Some immunosupressive drugs such as azathioprine, methotrexate and mycophenolate have been used to treat the disease,[9][failed verification] at the cost of exhacerbating the risk of infections and autoimmune diseases.[14] [non-primary source needed]

It has been found that appliying allylamine delayed the healing of the lesions.[4][non-primary source needed]

References

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  1. ^ "nec·ro·tiz·ing ar·ter·i·o·li·tis". medical-dictionary.thefreedictionary.com. The Free Dictionary by Farlex. Retrieved 12 August 2025.
  2. ^ Kelly, H. D. Brown (May 1956). "Granuloma of the Nose and Necrotizing Arteriolitis". The Journal of Laryngology & Otology. 70 (5): 313–316. doi:10.1017/S0022215100052956. PMID 13319935.
  3. ^ a b c "Pathogenesis of Hypertensive Arterial Necrosis". JAMA. 141 (4): 4. September 24, 1949. doi:10.1001/jama.1949.02910040028008.
  4. ^ a b R. Mellon, Ralph; R. Baker, Margaret; P. Mclroy, Alice (1935). "Experimental Necrotizing Arteriolitis Induced by a Protein Cleavage Product". Experimental Biology and Medicine. 33: 92–95. doi:10.3181/00379727-33-8263C. Retrieved 24 August 2025.
  5. ^ Raval, Prafulla (2007). "Systemic Necrotizing Vasculitis". XPharm: The Comprehensive Pharmacology Reference. pp. 1–5. doi:10.1016/B978-008055232-3.62933-2. ISBN 978-0-08-055232-3.
  6. ^ Atkinson, James B.; Johnson, Mahlon D.; Bouldin, Thomas W.; Whetsell, William O. (2009). "Muscle and Nerve Biopsy". Modern Surgical Pathology. pp. 2069–2088. doi:10.1016/B978-1-4160-3966-2.00053-9. ISBN 978-1-4160-3966-2.
  7. ^ Jennette, J. Charles; Falk, Ronald J. (2006). "Necrotizing Arteritis and Small Vessel Vasculitis". The Autoimmune Diseases. pp. 899–920. doi:10.1016/B978-012595961-2/50068-8. ISBN 978-0-12-595961-2.
  8. ^ Charles Jennette, J.; Falk, Ronald J. (2014). "Necrotizing Arteritis and Small Vessel Vasculitis". The Autoimmune Diseases. pp. 1067–1086. doi:10.1016/B978-0-12-384929-8.00072-1. ISBN 978-0-12-384929-8.
  9. ^ a b c d MedlinePlus Encyclopedia: Necrotizing vasculitis
  10. ^ Luger, Alan M.; Bauer, John H.; Neviackas, James A.; Lee, Hun Tae; Nichols, Kin (22 October 2008). "Primary Necrotizing Arteritis of the Main Renal Artery Presenting as Accelerated Renovascular Hypertension". American Journal of Nephrology. 1 (3–4): 168–172. doi:10.1159/000166534. PMID 7349049.
  11. ^ "arteriolitis". Oxford Reference.
  12. ^ Goldblatt, Harry (1 January 1947). "The Renal Origin of Hypertension". Physiological Reviews. 27 (1): 7, 35. doi:10.1152/physrev.1947.27.1.120. ISSN 0031-9333. PMID 20282156. Retrieved 24 August 2025.
  13. ^ Trumer, Commander (23 May 1963). "More on Necrotizing Arteriolitis". New England Journal of Medicine. 268 (21): 1201. doi:10.1056/NEJM196305232682131.
  14. ^ Vergara Serpa, Oscar Vicente; Velásquez-Franco, Carlos Jaime; Pinto, Luis Fernando; Pertuz Charris, Neil Smith; Echeverri García, Andrés Felipe; Cardona Palacio, Alejandro; Márquez Hernández, Javier Darío (July 2025). "De la inmunosupresión a la autoinmunidad: vasculitis ANCA-PR3+ en una paciente inmunosuprimida por trasplante hepático. Reporte de un caso" [From immunosuppression to autoimmunity: PR3+ ANCA-associated vasculitis in a patient immunosuppressed for hepatic transplant. A case report]. Revista Colombiana de Reumatología (in Spanish). 32 (3): 286–293. doi:10.1016/j.rcreu.2024.05.005.

Further reading

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1940s Papers

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  • Goldblatt, Harry (1940). "Extrarenal arteriolar necrosis and necrotizing arteriolitis". American Association for the Advancement of Science. Blood, Heart and Circulation.: 266–273.
  • Wilson, C; Pickering, G. W. (15 August 1938). "Acute Arterial Lesions in Rabbits with Experimental Renal Hypertension". Clinical Science. 3: 343–355.
  • Byrom, F. B.; Dodson, L. F. (July 1948). "The causation of acute arterial necrosis in hypertensive disease". The Journal of Pathology and Bacteriology. 60 (3): 357–368. doi:10.1002/path.1700600302.

2020s Papers

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  • Saha MK, Pendergraft WF, Jennette C, Falk RJ. Primaryu glomerular disease. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020 chap 31.
  • Free M, Jennette JC, Falk RJ, Jain K. Renal and systemic vasculitis. Comprehensive Clinical Nephrology. 7th ed. Philadelphia, PA: Elsevier; 2024 chap 26.
  • Dinulos JGH. Hypersensitivity syndromes and vasculitis. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021 chap 18.
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