Anticardiolipin Antibodies in Classic Pediatric Hemolytic-Uremic Syndrome: A Possible Pathogenic Role

Ardiles, Leopoldo; Olavarría, Fernando; Elgueta, M. Susana; Moya, Patricia; Mezzano, Sergio

doi:10.1159/000044936

Cited by 35 publications

(15 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These antiphospholipid antibodies, and in particular the aCL antibodies, have been associated with vascular thrombotic events such as recurrent venous thrombosis and thrombocytopenia [8,9]. Ardiles et al [10] investigated the presence of aCL in D+ HUS in children and studied the possible involvement of these antibodies in the microvascular lesions of D+ HUS. However, they could not conclude whether aCL antibodies play a pivotal role in HUS or whether they constitute an epiphenomenon.…”

Section: Introductionmentioning

confidence: 99%

Anticardiolipin antibodies in D+ hemolytic uremic syndrome

Loo

Velden

Onland

et al. 2002

Pediatric Nephrology

View full text Add to dashboard Cite

The diarrhea-associated form of the hemolytic uremic syndrome (D+ HUS) is characterized by a triad of symptoms, namely thrombocytopenia, hemolytic anemia, and acute renal failure. Histopathological studies of patients with D+ HUS show microthrombi in arterioles and glomeruli of the kidney. Recently, it was suggested that antiphospholipid antibodies might play a pathogenic role in D+ HUS. However, an epiphenomenon could not be excluded. In this study we investigated the relationship between antiphospholipid antibodies and clinical symptoms in 22 patients with the classical form of HUS (D+ HUS). The first sample was obtained on the day of admission. The next samples were taken on day 7 and 14. We measured anticardiolipin (aCL) antibodies (IgM, IgA, and IgG) in the samples using an ELISA. A significant increase in IgM (60%) and IgG (41%) aCL antibodies was seen in patients versus controls. No relationship between aCL antibody levels and severity of renal failure could be demonstrated. These data suggest that antiphospholipid antibodies are increased, but have not been shown to have a role in the pathogenesis of the microangiopathy seen in D+HUS.

show abstract

Section: Introductionmentioning

confidence: 99%

Anticardiolipin antibodies in D+ hemolytic uremic syndrome

Loo

Velden

Onland

et al. 2002

Pediatric Nephrology

View full text Add to dashboard Cite

show abstract

“…A total of 63 patients with TMHA associated with aPL were found in the literature search, but 18 of them (corresponding to six articles) [20][21][22][23][24][25] were not included because their clinical and immunological characteristics were not described. 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.…”

Section: Resultsmentioning

confidence: 99%

“…Although aPL have not commonly been detected in primary TTP 54 55 or HUS, 20 there are some data favouring a causal relationship. Ardiles et al studied 17 patients presenting with diarrhoea associated HUS.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathic haemolytic anaemia and antiphospholipid antibodies

Espinosa

Bucciarelli²,

Cervera³

et al. 2004

Annals of the Rheumatic Diseases

143

View full text Add to dashboard Cite

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.

show abstract

“…A few authors have described them associated with glomerular thrombosis in lupus nephropathy with different interpretations about their role in the pathogenesis of the renal disease [3, 21]. Anecdotal cases have been published reporting antiphospholipid antibodies in nonlupus renal diseases such as Henoch-Schönlein purpura [5], postpartum hemolytic-uremic syndrome [22], and the classical pediatric form of hemolytic-uremic syndrome [14]. …”

Section: Discussionmentioning

confidence: 99%

“…aCLs were identified in the serum using a solid-phase immunoenzymatic assay (ELISA), following the recommendations of Harris [13], as published previously [14]. Briefly, micro-ELISA plates were coated with 30 µl of cardiolipin (Sigma), 50 µg/ml diluted in ethanol.…”

Section: Methodsmentioning

confidence: 99%

Anticardiolipin Antibodies in Acute Poststreptococcal Glomerulonephritis and Streptococcal Impetigo

Ardiles

Ramı́rez

Moya

et al. 1999

Nephron

Self Cite

View full text Add to dashboard Cite

Anticardiolipin (aCL) antibodies have been described in diverse clinical situations, linked to the risk of thrombosis in different vascular locations. They have been rarely studied in renal diseases, and occasionally they have been associated with glomerular thrombosis. We analyzed the incidence of aCL (isotypes IgG, IgA, and IgM) in samples, taken during the acute phase of the disease, from 27 well-documented patients having acute poststreptococcal glomerulonephritis. Twelve cases were positive on IgG testing, 1 case on IgA testing only, and no one was positive on IgM testing. A serological follow-up was performed with a second sample taken about 7 months later, for the patients initially positive on IgG testing showing persistence in 9. Clinical variables during the acute phase and after a follow-up period of 25 (range 6–89) months were analyzed for possible associations with the presence of these antibodies, but non was significantly related. Renal histopathological investigation did not reveal particular findings in the aCL-positive patients, and glomerular thrombosis was not found in any case. In addition, serum samples from 12 streptococcal impetigo patients without renal involvement were analyzed, showing similar incidence (4 positive on IgG testing, 1 of them positive on IgM testing as well, and no one positive on IgA testing) and titers of aCL antibodies. We conclude that the presence of aCL antibodies in acute poststreptococcal glomerulonephritis may be a marginal immunological phenomenon unrelated to the glomerular disease, triggered by the streptococcal infection.

show abstract

Anticardiolipin Antibodies in Classic Pediatric Hemolytic-Uremic Syndrome: A Possible Pathogenic Role

Cited by 35 publications

References 12 publications

Anticardiolipin antibodies in D+ hemolytic uremic syndrome

Anticardiolipin antibodies in D+ hemolytic uremic syndrome

Thrombotic microangiopathic haemolytic anaemia and antiphospholipid antibodies

Anticardiolipin Antibodies in Acute Poststreptococcal Glomerulonephritis and Streptococcal Impetigo

Contact Info

Product

Resources

About