Acute Renal Failure as First Clinical Manifestation of the Primary Antiphospholipid Syndrome

Lacueva, Javier; Enríquez, R; Cabezuelo, J B; Arenas, María Dolores; Teruel, Ana; González, Cristina M.

doi:10.1159/000187378

Cited by 29 publications

(18 citation statements)

References 2 publications

(2 reference statements)

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“…Because of this, 46 patients-45 from the literature 4 5 13 14 26-51 and one from our clinics (see appendix 1)-with 47 episodes of TMHA (one patient had two episodes of TMHA 40 ) were finally reviewed. Table 1 shows the general clinical features of the complete series of patients.…”

Section: Resultsmentioning

confidence: 99%

Thrombotic microangiopathic haemolytic anaemia and antiphospholipid antibodies

Espinosa

Bucciarelli²,

Cervera³

et al. 2004

Annals of the Rheumatic Diseases

142

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Objective: To analyse the clinical and laboratory features of patients with thrombotic microangiopathic haemolytic anaemia (TMHA) associated with antiphospholipid antibodies (aPL). Methods: A computer assisted (PubMed) search of the literature was performed to identify all cases of TMHA associated with aPL from 1983 to December 2002. Results: 46 patients (36 female) with a mean (SD) age at presentation of TMHA of 34 (15) years were reviewed. Twenty eight (61%) patients had primary antiphospholipid syndrome (APS). TMHA was the first clinical manifestation of APS in 26 (57%) patients. The clinical presentations were haemolytic-uraemic syndrome (26%), catastrophic APS (23%), acute renal failure (15%), malignant hypertension (13%), thrombotic thrombocytopenic purpura (13%), and HELLP (haemolysis, elevated liver enzymes, and low platelet count in association with eclampsia) syndrome (4%). Lupus anticoagulant was detected in 86% of the episodes of TMHA, and positive anticardiolipin antibodies titres in 89%. Steroids were the most common treatment (69% of episodes), followed by plasma exchange (PE) (62%), anticoagulant or antithrombotic agents (48%), immunosuppressive agents (29%), and immunoglobulins (12%). Recovery occurred in only 10/29 (34%) episodes treated with steroids, and in 19/27 (70%) episodes treated with PE. Death occurred in 10/46 (22%) patients. Conclusions:The results emphasise the need for systematic screening for aPL in all patients with clinical and laboratory features of TMHA. The existence of TMHA in association with an APS forces one to rule out the presence of the catastrophic variant of this syndrome. PE is indicated as a first line of treatment for all patients with TMHA associated with aPL.

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Section: Resultsmentioning

confidence: 99%

Thrombotic microangiopathic haemolytic anaemia and antiphospholipid antibodies

Espinosa

Bucciarelli²,

Cervera³

et al. 2004

Annals of the Rheumatic Diseases

142

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“…Intrarenal TMA may be the first manifestation that leads to a diagnosis of primary APS [74]. It has been emphasized that APS should be considered in the differential diagnosis of systemic hypertension and, that APS-related TMA may cause isolated hypertension without significant renal impairment.…”

Section: Intrarenal Vascular Lesionsmentioning

confidence: 99%

“…Control of hypertension, associated with various other drugs (anti-platelet drugs, anti-coagulants, steroids or rarely plasma exchange) may lead to remarkable improvement in renal function [1,67,74,95,96].…”

Section: Treatmentmentioning

confidence: 99%

Kidney disease in primary anti-phospholipid antibody syndrome

Gracia-Tello

Isenberg

2016

Rheumatology

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APS is an autoimmune disease defined by the presence of arterial or venous thrombotic events and/or pregnancy morbidity in patients who test positive for aPL. APS can be isolated (primary APS) or associated with other autoimmune diseases. The kidney is a major target organ in APS, and renal thrombosis can occur at any level within the vasculature of the kidney (renal arteries, intrarenal vasculature and renal veins). Histological findings vary widely, including ischaemic glomeruli and thrombotic lesions without glomerular or arterial immune deposits on immunofluorescence. Renal involvement in patients with definite APS is treated with long-term anticoagulants as warfarin, but new treatments are being tried. The aim of this article is to review the links between primary APS and kidney disease.

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“…Dear Sir, The kidney is now recognized as another target organ in the antiphospholipid syn drome (AS) [1], Renal involvement is consis tent with thrombosis o f the major renal ves sels and noninflammatory microvascular disease [2][3][4], In the clinical findings renal failure has been emphasized over systemic hypertension.…”

Section: Malignant Hypertension and Antiphospholipid Syndromementioning

confidence: 99%