Glomerulonephritis in Takayasu arteritis is dominated by mesangial and AA amyloid lesions and often arises during remission: a case-based review

Takayasu arteritis (TAK) is a large-vessel vasculitis in which glomerulonephritis is a rare complication with a poorly characterized clinical and histopathological profile. Patients with biopsy-proven glomerulonephritis were retrospectively identified from a single-center TAK cohort followed between 2014 and 2022. A systematic review of PubMed/MEDLINE, Scopus, and Web of Science for articles published up to December 2025 was conducted in parallel, excluding studies involving patients younger than 18 years and cases with confounding autoimmune conditions or non-classifiable biopsy findings. This case-based review was reported in accordance with the CABARET and PRISMA 2020 standards. Among 72 patients with TAK, three (4.2%) had biopsy-proven glomerulonephritis. The systematic review yielded 31 articles describing 39 additional cases (84.6% female; median age at TAK diagnosis 26 years; median age at glomerular disease diagnosis 33 years). Glomerular disease was diagnosed a median of 5 years (IQR 0-11) after TAK and most often presented as asymptomatic proteinuria or nephrotic syndrome. Mesangial proliferative glomerulonephritis was the most common subtype (35.9%), followed by AA amyloidosis (30.8%), membranoproliferative glomerulonephritis (12.8%), focal segmental glomerulosclerosis (10.3%), and membranous nephropathy (7.7%). Renal artery stenosis was absent in 69.2% of cases. Corticosteroids were used in 92.3% of cases and biologic agents in 10.3%. Glomerulonephritis is a rare but clinically significant late complication of TAK, characterized by a distinct histopathological spectrum dominated by mesangial lesions, AA amyloidosis, and membranoproliferative glomerulonephritis. Routine proteinuria screening in patients with TAK, including during clinical remission, is warranted to enable early detection and timely management.