Noninflammatory Renal Microangiopathy of Systemic Lupus Erythematosus (‘Lupus Vasculitis’)

Abstract

5 (group 1) of 9 patients with systemic lupus erythematosus (SLE) who underwent a kidney biopsy during a 1 -year period had a noninflammatory renal microangiopathy which significantly narrowed or occluded the lumens of arterioles and terminal segments of interlobular arteries. Though these lesions resemble those of malignant hypertension and the thrombotic microangiopathies, their distinctive features, revealed by light, immunofluorescence and electron microscopy, differentiate them from the others. 4 of these 5 (group 1) patients developed hypertension; in 3 the microangiopathy predated the hypertension. None of the remaining 4 (group 2) patients without these lesions has become hypertensive. One group-1 patient with extensive lesions involving 40 % of intrarenal arterioles at biopsy developed renal failure shortly thereafter with increasing arteriolar involvement but unchanged glomerular histology.

Systemic and Renal Fibrinolytic Activity in a Patient with Anticardiolipin Syndrome and Renal Thrombotic Microangiopathy

“…As in our patient, no histological evidence of lupus glomerulo nephritis or vasculitis was found. This suggests that arte riolar and glomerular thromboses, previously related to lupus vasculitis [8], could in fact represent a conse quence of antiphospholipid antibodies.…”

“…This suggested that renal vascular or glomerular thromboses, which occur more frequently in patients with lupus nephritis when circulating lupus anticoagulant is present [7]. are not always a manifestation of renal vasculitis [8] but can be related to a thrombogenic effect of antiphos pholipid antibodies.…”

Anticardiolipin Antibodies in South African Patients with Lupus Nephritis: A Clinical and Renal Pathological Study

“…A formal search was conducted for the presence of intrarenal microvascular thrombosis (glomerular capillary and arteriolar) as well as for other grades of TMA. An attempt was made to distinguish fibrin thrombi from 'hyaline thrombi' as the latter represent deposits of immune complexes within the microvasculature and generally indicate a high level of histological activity [15]. These hyaline thrombi are characteristically not accompanied by inflammatory changes in the vessel wall and, on IMF microscopy, contain mainly immunoglobulins and complement [15].…”

“…An attempt was made to distinguish fibrin thrombi from 'hyaline thrombi' as the latter represent deposits of immune complexes within the microvasculature and generally indicate a high level of histological activity [15]. These hyaline thrombi are characteristically not accompanied by inflammatory changes in the vessel wall and, on IMF microscopy, contain mainly immunoglobulins and complement [15]. Intraglomerular thrombosis was only considered to be present if total or near total occlusion of a glomerular capillary lumen by fibrin was noted.…”

Kidney Disease in Antiphospholipid Syndrome

“…The association of the distinctive lesion known as thrombotic microangiopathy (TMA) with aPL was initially described in patients with SLE [25][26][27]. In another clinical setting, Kincaid-Smith and coworkers [28] showed acute or healed TMA in 22 biopsies obtained in 12 patients with LA and pregnancy-related renal failure.…”