Antiphospholipid syndrome presenting as unilateral renal artery occlusion: case report and literature review

Abstract

The objective of this study is to report a case of primary antiphospholipid syndrome (APS) presenting as complete renal artery occlusion, and to review the literature on the subject. We describe the clinical presentation, course and outcome of one patient who presented with resistant hypertension later found to be due to thrombosis and complete occlusion of the left renal artery. We review the medical literature registered in the Medline PubMed database from 1966 to 2004 using keywords: antiphospholipid, Hughes syndrome, kidney, renal, renal artery thrombosis. We describe one patient and analyzed ten well-documented cases of renal artery thrombosis due to APS. Most of the patients were women, at a mean age of 32 years. All but one case had primary APS. The presenting symptom was hypertension in ten cases. Most patients had both lupus anticoagulant and anticardiolipin antibodies. Arterial occlusion was left sided in 55%, right sided in 27% and bilateral in 18%. Renal artery thrombosis is an uncommon presentation of APS. This entity should be considered in the differential diagnosis of severe hypertension.

Renal artery stenosis with significant proteinuria may be reversed after nephrectomy or revascularization in patients with the antiphospholipid antibody syndrome: a case series and review of the literature

“…In a multivariate analysis, RAS in APS\APL correlated only with elevated C-reactive protein (CRP) but not with traditional atherosclerotic risk factors [31]. In addition to these large cohorts, various cases of APS and RAS were described in the literature [7,32].…”

“…The common etiologies of RAS are atherosclerosis and Wbromuscular dysplasia [3,4]. In recent years, RAS has been also documented in patients with the antiphospholipid syndrome (APS) [5][6][7]. Therefore, in considering the diVerential diagnosis of nephrotic range proteinuria in patients with APS, renal artery stenosis should be sought in addition to other reasons such as glomerular involvement secondary to primary APS or to related diseases such as systemic lupus erythematousus (SLE).…”

Antiphospholipid syndrome and kidney disease

“…The management of renal artery or vein thrombosis in the context of APS is not specific and is based mainly on efficient anticoagulation. Occasionally percutaneous angioplasty, 63 thrombolysis, 64 or nephrectomy of a compromised kidney to control hypertension 20,65 have been used successfully. Prevention of thrombosis recurrence in patients with definite APS is a critical aspect of long-term patient management.…”

Поражение Почек На Фоне Антифосфолипидного Синдрома

“…Тромбоз почечной вены вследствие АФС может проявляться протеинурией в нефротическом диапазоне, гематурией, олигурией и анурией вследствие острого повреждения почек. Следовательно, ухудшение течения нефропатии у пациентов с СКВ, позитивных по аФЛ-и аКЛ-АТ, в виде необъяснимо нарастающей протеинурии, гематурии или острой задержки мочи [31] должно насторожить врача в плане тромбоза почечной вены.…”