Kidney nontumor
Non-ANCA vasculitis
Polyarteritis nodosa

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 20 November 2018, last major update December 2012

Copyright: (c) 2003-2018,, Inc.

PubMed Search: Polyarteritis nodosa [title] kidney pathology

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Cite this page: Sangle, N. Polyarteritis nodosa. website. Accessed January 21st, 2019.
Definition / general
  • Primary vasculitis of unknown etiology that affects muscular arteries at branch points
  • Produces lesions of varying stages of evolution, also aneurysms
  • Usually affects kidney (80%) and GI tract
Clinical features
  • 2 cases per million, 2/3 male, ages 50+ years
  • 1/3 of cases are hepatitis B carriers
  • Causes renal infarct, hypertension (often severe or malignant)
  • May present with rapidly progressive renal insufficiency (Clin Nephrol 2010;74:315)
  • < 20% have positive p-ANCA
Case reports
Microscopic (histologic) description
  • Necrotizing vasculitis of renal, interlobar and arcuate arteries at branch points with aneurysmal dilatation, fibrinoid necrosis and neutrophilic infiltration of vessel wall, often with thrombosis
  • Later have mononuclear infiltrate, fibrosis of media and perivascular tissue and recanalization of thrombosed vessel
  • Often not detected in biopsy since lesions are focal
  • Glomeruli show ischemic changes of collapse and sclerosis
Microscopic (histologic) images

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Lymphocytic vasculitis of renal vessels

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Neutrophilic infiltration of vessels

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Inflammation and fibrinoid necrosis

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Small artery has inflammation
and red staining (fibrinoid) due to
penetration of plasma into vessel wall
Immunofluorescence description
  • No deposits
Electron microscopy description
  • No deposits
Differential diagnosis
  • Kawasaki's disease: more mural edema and infiltrating monocytes, less fibrinoid necrosis