Infarctus rénaux au cours d’un lupus avec syndrome des antiphospholipides : implication du sevrage en hydroxychloroquine ? Commentaire à propos de l’article de Szymezak et al.

Zénone, Thierry; Knefati, Yannick

doi:10.1016/j.revmed.2011.01.006

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…Patients with SLE that are stable with treatment, mainly hydroxychloroquine, at the moment of pharmacologic withdrawal may have this complication ( 35 ).…”

Section: Introductionmentioning

confidence: 99%

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Renal Involvement in Antiphospholipid Syndrome

2018

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Antiphospholipid syndrome is a complex autoimmune disease, characterized by the presence of vascular thrombosis, obstetric, hematologic, cutaneous, and cardiac manifestations. Renal disease in patients with antiphospholipid syndrome was not recognized in the first descriptions of the disease, but later on, the renal manifestations of the syndrome have been investigated widely. Renal manifestations of antiphospholipid syndrome conform a wide spectrum of diverse renal syndromes. Hypertension is one of the most frequent, but less commonly recognized renal alteration. It can be difficult to control as its origin is renovascular. Renal vascular thrombosis can be arterial or venous. Other alterations are renal infarction and vascular thrombosis in arterial territories. Venous thrombosis can be present in primary and secondary antiphospholipid syndrome; it presents with worsening of previous proteinuria or de novo nephrotic syndrome, hypertension and renal failure. Antiphospholipid syndrome nephropathy is a vascular disease that affects glomerular tuft, interstitial vessels, and peritubular vessels; histopathology characterizes the renal lesions as acute or chronic, the classic finding is thrombotic microangiopathy, that leads to fibrosis, tubule thyroidization, focal cortical atrophy, and glomerular sclerosis. Antiphospholipid syndrome nephropathy can also complicate patients with systemic lupus erythematosus, and there is vast information supporting the worse renal prognosis in this group of patients with the classic histopathologic lesions. Treatment consists of anticoagulation, as for other thrombotic manifestations of antiphospholipid syndrome. There is some evidence of glomerulonephritis as an isolated lesion in patients with antiphospholipid syndrome. The most frequently reported glomerulonephritis is membranous; with some reports suggesting that immunosuppressive treatment may be effective. Patients with end stage renal disease commonly are positive for antiphospholipid antibodies, but it is not clear what is the role of aPL in this setting. Patients with vascular access may have complications in the presence of antibodies so that anticoagulation is recommended. Patients ongoing renal transplant with persistent antiphospholipid antibody positivity may have early and late graft failure.

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“…Patients with SLE that are stable with treatment, mainly hydroxychloroquine, at the moment of pharmacologic withdrawal may have this complication ( 35 ).…”

Section: Introductionmentioning

confidence: 99%

“…Erkan et al in a prospective study that included 39 patients with APS found that only 1 patient developed ESRD during the 10 years follow up ( 64 ). Other studies have investigated this relationship ( 35 ). Sinico et al, studied retrospectively 160 APS patients, and only 1 developed ESRD ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Renal Involvement in Antiphospholipid Syndrome

2018

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Antiphospholipid syndrome and kidney disease

Bienaimé

Legendre

Terzi

et al. 2017

Kidney International

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The antiphospholipid syndrome is a common autoimmune disease caused by pathogenic antiphospholipid antibodies, leading to recurrent thrombosis and/or obstetrical complications. Importantly for nephrologists, antiphospholipid antibodies are associated with various renal manifestations including large renal vessel thrombosis, renal artery stenosis, and a constellation of intrarenal lesions that has been termed antiphospholipid nephropathy. This last condition associates various degrees of acute thrombotic microangiopathy, proliferative and fibrotic lesions of the intrarenal vessels, and ischemic modifications of the renal parenchyma. The course of the disease can range from indolent nephropathy to devastating acute renal failure. The pejorative impact of antiphospholipid antibody-related renal complication is well established in the context of systemic lupus erythematous or after renal transplantation. In contrast, the exact significance of isolated antiphospholipid nephropathy remains uncertain. The evidence to guide management of the renal complications of antiphospholipid syndrome is limited. However, the recent recognition of the heterogeneous molecular mechanisms underlying the progression of intrarenal vascular lesions in antiphospholipid syndrome have opened promising tracks for patient monitoring and targeted therapeutic intervention.

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Renal involvement in antiphospholipid syndrome

et al. 2014

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Antiphospholipid syndrome (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 antiphospholipid antibodies (aPL). APS can be isolated (known as primary APS) or associated with other autoimmune diseases, such as systemic lupus erythematosus (SLE; known as secondary APS). 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 arteries, glomerular capillaries and renal veins);events reflect the site and size of the involved vessels. Histological findings vary widely, including ischaemic glomeruli and thrombotic lesions, without glomerular or arterial immune deposits on immunofluorescence. Renal prognosis is affected by the presence of aPL in patients with lupus nephritis and can be poor. In patients with SLE and aPL, biopsy should be performed because inflammatory and thrombotic lesions require different therapeutic approaches. Renal involvement in patients with definite APS is treated by anticoagulation with long-term warfarin. The range of renal manifestations associated with APS is broadening and, therefore, aPL has increasing relevance in end-stage renal disease, transplantation and pregnancy.

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Infarctus rénaux au cours d’un lupus avec syndrome des antiphospholipides : implication du sevrage en hydroxychloroquine ? Commentaire à propos de l’article de Szymezak et al.

Cited by 3 publications

References 4 publications

Renal Involvement in Antiphospholipid Syndrome

Renal Involvement in Antiphospholipid Syndrome

Antiphospholipid syndrome and kidney disease

Renal involvement in antiphospholipid syndrome

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