Post-partum bilateral renal cortical necrosis in antiphospholipid syndrome and systemic lupus erythematosus

Vellanki, Venkat Sainaresh; Sriramnaveen, P; Sivaramakrishna, G.; Yadla, Manjusha; Chenu, Krishna Kishore; Vishnubhotla, Sivakumar

doi:10.4103/1319-2442.111064

Cited by 5 publications

(1 citation statement)

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“…Patients affected by SLE share with other CKD patients the traditional risk factors for adverse pregnancy outcomes, but they have also specific risks of p-AKI including lupus flares, preeclampsia, HELLP syndrome, and thrombotic events. The major predictors for acute pregnancy-related complications are Class III and IV lupus nephritis, a previous history of renal flares, longer disease, hypocomplementemia, antiphospholipid syndrome (APS), and the presence of antiphospholipid antibodies [ 132 , 133 , 134 , 135 , 136 ]. In this context, high titres and triple positivity for antiphospholipid antibodies, previous thrombosis and the presence of a lupus anticoagulant are associated with a higher risk of severe maternal and foetal complications, both in primary and secondary APS, and in catastrophic APS (CAPS) the most severe form of the syndrome [ 136 , 137 , 138 , 139 , 140 , 141 , 142 ].…”

Section: The Role Of Immunologic Diseases In the Pathogenesis Of Tmentioning

confidence: 99%

Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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Pregnancy-related acute kidney injury (pAKI), preeclampsia (PE), and the hypertensive disorders of pregnancy are closely related conditions, which are, in turn, frequently linked to pre-existing and often non-diagnosed chronic kidney disease (CKD). The current literature and research mainly underline the effects of pregnancy complications on the offspring; this review strongly emphasizes the maternal health as well. These conditions not only negatively affect pregnancy outcomes, but have a relevant effect on the future health of affected mothers and their children. Therefore, dedicated diagnostic and follow-up programs are needed, for optimizing materno-foetal health and reducing the impact of pregnancy-related problems in the mothers and in the new generations. This narrative review, performed on the occasion of the 2018 World Kidney Day dedicated to women’s health, focuses on three aspects of the problem. Firstly, the risk of AKI in the hypertensive disorders of pregnancy (the risk is the highest in developing countries; however PE is the main cause of pregnancy related AKI worldwide). Secondly, the effect of AKI and the hypertensive disorders of pregnancy on the development of CKD in the mother and offspring: long-term risks are increased; the entity and the trajectories are still unknown. Thirdly, the role of CKD in the pathogenesis of AKI and the hypertensive disorders of pregnancy: CKD is a major risk factor and the most important element in the differential diagnosis; pregnancy is a precious occasion for early diagnosis of CKD. Higher awareness on the importance of AKI in pregnancy is needed to improve short and long term outcomes in mothers and children.

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Section: The Role Of Immunologic Diseases In the Pathogenesis Of Tmentioning

confidence: 99%

Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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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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Post-partum bilateral renal cortical necrosis in antiphospholipid syndrome and systemic lupus erythematosus

Cited by 5 publications

References 0 publications

Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases

Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases

Antiphospholipid syndrome and kidney disease

Renal involvement in antiphospholipid syndrome

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