Renal artery stenosis in the antiphospholipid (Hughes) syndrome and hypertension

Renal artery stenosis: a new facet of the antiphospholipid (Hughes) syndrome

“…In general, stenotic lesions in the APS group showed a unique pattern of smooth, well delineated narrowings at the proximal and the middle segments of the renal arteries in 70% of patients, these lesions clearly differing from those seen in atherosclerosis or bromuscular dysplasia. 9 These stenotic lesions therefore appear to be a new lesion in the spectrum of reno-vascular disease. Whilst this data implicates renal artery stenosis as a signi cant cause of hypertension in APS, true renal disease may also contribute to both hypertension and the renal dysfunction.…”

“…8 This work has now been con rmed and considerably extended. 9 In a study of 77 patients with APS and poorly controlled hypertension, magnetic resonance angiography imaging was used to visualize the renal arteries. Twenty patients (28%) had renal artery lesions, their mean age being 44.…”

“…Thrombosis in the renal arteries and veins has previously been reported. 9,10 Beyond this propensity to thrombosis there is also evidence that patients with APS may develop accelerated atherosclerosis.…”

The Kidney in Antiphospholipid Syndrome

“…Another patient described by Ames and collaborators presented hypertension and oliguria, bilateral renal artery occlusions on renal arteriography and high titers of circulating aPL [Ames et al, 1992]. Sangle et al, using magnetic resonance angiography, identified that 26% of the aPL-positive patients with severe, poorly controlled arterial hypertension had renal artery stenosis, compared with 8% in young aPL-negative hypertensive patients [Sangle et al, 2003]. The renal artery stenosis in aPL-positive patients has two patterns.…”

“…Imagistic methods such as renal ultrasonography (including main renal artery Doppler ultrasonography), computed tomography, renal scintigraphy, renal angiography, and gadolinium enhanced magnetic resonance angiography contribute to the diagnosis and severity assessment of the renal arteries lesions [Mandreoli, Zuccheli, 1993;Sangle et al, 2003]. …”