Yonsei Med J.  2013 Jan;54(1):189-196. 10.3349/ymj.2013.54.1.189.

Renal Manifestations in 2007 Korean Patients with Behcet's Disease

• Cho SB
• Kim J
• Kang SW
• Yoo TH
• Zheng Z
• Cho S
• Lee HS
• Bang D

• KMID: 1776937
• DOI: http://doi.org/10.3349/ymj.2013.54.1.189

Abstract

PURPOSE
Behcet's disease (BD) theoretically affects all sizes and types of blood vessels and results in multi-organ involvement. However, renal BD has not been fully characterized, though the kidneys are histologically rich in blood vessels.
MATERIALS AND METHODS
A total of 2007 patients who fulfilled the diagnostic criteria for BD were enrolled in this study. We reviewed the medical records and test results of the BD patients and used univariate and multivariate logistic regression analyses to determine the clinical significance of renal involvement in BD.
RESULTS
Among the 2007 BD patients, we noted hematuria in 412 (20.5%) and proteinuria in 29 (1.4%). Univariate analysis showed that the BD patients with hematuria were predominantly female and older, had higher erythrocyte sedimentation rates (ESRs), and more frequently presented with genital ulcerations. BD patients with proteinuria had higher ESR levels compared to BD patients without proteinuria. In the multivariate analysis, age, sex, and ESR were found to be significantly associated with hematuria in BD patients, whereas only ESR was associated with proteinuria in BD patients. We also found that IgA nephropathy was the most common pathologic diagnosis in 12 renal BD patients who underwent renal biopsies.
CONCLUSION
We suggest that routine urinalysis and serum renal function tests be performed for the early detection of renal BD, especially in older female BD patients with recurrent hematuria, high ESR levels, and frequent genital ulcers, as well as in BD patients with proteinuria and high ESR levels.

Keyword

Behcet's disease; renal involvement; hematuria; proteinuria; IgA nephropathy

MeSH Terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Behcet Syndrome/*complications/epidemiology/*metabolism
Biopsy
Female
Glomerulonephritis, IGA/complications/diagnosis
Hematuria/complications/diagnosis
Humans
Kidney/*pathology
Kidney Diseases/*diagnosis
Logistic Models
Male
Middle Aged
Multivariate Analysis
Proteinuria/complications/diagnosis
Republic of Korea
Young Adult

Reference

1. Sakane T, Takeno M, Suzuki N, Inaba G. Behçet's disease. N Engl J Med. 1999. 341:1284–1291.

2. Akpolat T, Akkoyunlu M, Akpolat I, Dilek M, Odabas AR, Ozen S. Renal Behçet's disease: a cumulative analysis. Semin Arthritis Rheum. 2002. 31:317–337.

3. Akpolat T, Dilek M, Aksu K, Keser G, Toprak O, Cirit M, et al. Renal Behçet's disease: an update. Semin Arthritis Rheum. 2008. 38:241–248.

4. International Study Group for Behçet's Disease. Criteria for diagnosis of Behçet's disease. Lancet. 1990. 335:1078–1080.

5. Higashihara E, Nishiyama T, Horie S, Marumo K, Mitarai T, Koyama T, et al. Hematuria: definition and screening test methods. Int J Urol. 2008. 15:281–284.

6. Oshima Y, Shimizu T, Yokohari R, Matsumoto T, Kano K, Kagami T, et al. Clinical Studies on Behçet's Syndrome. Ann Rheum Dis. 1963. 22:36–45.

7. Kavala M, Menteş F, Kocaturk E, Ergin H, Zindanci I, Can B, et al. Microalbuminuria as an early marker of renal involvement in Behcet's disease: it is associated with neurological involvement and duration of the disease. J Eur Acad Dermatol Venereol. 2010. 24:840–843.

8. Numo R, Lapadula G, Covelli M, Telrizzi N. O'Duffy JD, Kokmen E, editors. Kidney involvement in a series of cases of Behçet's disease. Behçet's disease: Basic and clinical aspects. 1991. New York: Marcel Dekker;303–308.

9. Altiparmak MR, Tanverdi M, Pamuk ON, Tunç R, Hamuryudan V. Glomerulonephritis in Behçet's disease: report of seven cases and review of the literature. Clin Rheumatol. 2002. 21:14–18.

10. Fernandes PF, Júnior GB, Barros FA, Sousa DC, Franco LM, Patrocínio RM. Behcet's disease and IgA nephropathy: report of this association in a patient from Brazil and literature review. Invest Clin. 2006. 47:405–411.

11. Akutsu Y, Itami N, Tanaka M, Kusunoki Y, Tochimaru H, Takekoshi Y. IgA nephritis in Behçet's disease: case report and review of the literature. Clin Nephrol. 1990. 34:52–55.

12. Yang CW, Park IS, Kim SY, Chang YS, Yoon YS, Bang BK, et al. Antineutrophil cytoplasmic autoantibody associated vasculitis and renal failure in Behçet disease. Nephrol Dial Transplant. 1993. 8:871–873.

13. Khan IH, Catto GR, MacLeod AM. Antineutrophil cytoplasmic antibody associated vasculitis and renal failure in Behçet's disease. Nephrol Dial Transplant. 1994. 9:332.

14. Lehner T, Batchelor JR, Challacombe SJ, Kennedy L. An immunogenetic basis for the tissue involvement in Behçet's syndrome. Immunology. 1979. 37:895–900.

15. Glassock RJ, Adler SG, Ward HJ, Cohen AH. Brenner BM, Rector FC, editors. Primary glomerular disease. The kidney. 1991. Philadelphia: WB Saunders;1203–1209.

16. Li JJ, Lee SH, Kim DK, Jin R, Jung DS, Kwak SJ, et al. Colchicine attenuates inflammatory cell infiltration and extracellular matrix accumulation in diabetic nephropathy. Am J Physiol Renal Physiol. 2009. 297:F200–F209.

17. Cho SB, Kim T, Cho S, Shim WH, Yang MS, Bang D. Major arterial aneurysms and pseudoaneurysms in Behçet's disease: results from a single centre. Scand J Rheumatol. 2011. 40:64–67.