Reversible bilateral hydronephrosis without obstruction in hepatitis B-associated polyarteritis nodosa

The manifestations of polyarteritis nodosa (PAN) are varied, but urological abnormalities other than ureteric stenosis and orchitis have not been desc ribed. We report a case of hepatitis B-associated PAN with bilateral hydron ephrosis without obstruction. Retrograde urography conclusively demonstrate d the absence of obstruction. Vasculitis-related myopathy, or neuropathy of the ureter, is the most likely cause of this finding. The patient was trea ted with high-dose steroids, cyclophosphamide, and plasmapheresis with reso lution of hydronephrosis. Although the patient required dialysis at initiat ion of therapy, she went on to recover sufficient renal function to discont inue dialysis. We review the literature on the treatment of hepatitis a-ass ociated PAN and discuss the pitfalls in diagnosis of this condition. (C) 19 99 by the National Kidney Foundation, Inc.