Renal and vascular outcomes in patients with isolated antiphospholipid syndrome nephropathy

Rousselin, Clémentine; Amoura, Zahir; Faguer, Stanislas; Bataille, Pierre; Boffa, Jean‐Jacques; Canaud, Guillaume; Guerrot, Dominique; GCLR, Noémie Jourde-Chiche for the; Karras, Alexandre; Auxenfants, É.; Chapelet, Agnès; Lambert, Marc; Behal, Hélène; Nochy, Dominique; Jean-Paul, Duong Van Huyen; CFPR, Isabelle Brocheriou for the; Gnemmi, Viviane; Quéméneur, T.

doi:10.1016/j.jaut.2022.102889

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…Renal biopsies can also help in lupus patients due to potential clinical similarities between LN flares and PE ( 113 , 114 ). In APL cases, the presence of acute TMA in glomerular and arteriolar lesions alongside chronic vascular changes aids in diagnosis ( 115 ).…”

Section: Does Histopathological Analysis Offer Insights Into Distingu...mentioning

confidence: 99%

Pregnancy as a susceptible state for thrombotic microangiopathies

Frimat,

Gnemmi,

Stichelbout

et al. 2024

Front. Med.

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Pregnancy and the postpartum period represent phases of heightened vulnerability to thrombotic microangiopathies (TMAs), as evidenced by distinct patterns of pregnancy-specific TMAs (e.g., preeclampsia, HELLP syndrome), as well as a higher incidence of nonspecific TMAs, such as thrombotic thrombocytopenic purpura or hemolytic uremic syndrome, during pregnancy. Significant strides have been taken in understanding the underlying mechanisms of these disorders in the past 40 years. This progress has involved the identification of pivotal factors contributing to TMAs, such as the complement system, ADAMTS13, and the soluble VEGF receptor Flt1. Regardless of the specific causal factor (which is not generally unique in relation to the usual multifactorial origin of TMAs), the endothelial cell stands as a central player in the pathophysiology of TMAs. Pregnancy has a major impact on the physiology of the endothelium. Besides to the development of placenta and its vascular consequences, pregnancy modifies the characteristics of the women’s microvascular endothelium and tends to render it more prone to thrombosis. This review aims to delineate the distinct features of pregnancy-related TMAs and explore the contributing mechanisms that lead to this increased susceptibility, particularly influenced by the “gravid endothelium.” Furthermore, we will discuss the potential contribution of histopathological studies in facilitating the etiological diagnosis of pregnancy-related TMAs.

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Section: Does Histopathological Analysis Offer Insights Into Distingu...mentioning

confidence: 99%

Pregnancy as a susceptible state for thrombotic microangiopathies

Frimat,

Gnemmi,

Stichelbout

et al. 2024

Front. Med.

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“…A persistent detection of anti-phospholipids (>12 weeks) is retrieved in 20-40% of SLE patients, which increases the risk of arterial/venous thrombosis and/or pregnancy morbidity [89]. Among LN patients, 5-15% of them present glomerular microvascular damage at biopsy that defines anti-phospholipid nephropathy (APSN) [90], and this distinct histological feature and independent risk factor for ESKD development results from the presence of an acute and/or chronic thrombotic microangiopathy (TMA) together with serum anti-phospholipid Ab detection [91,92]. APSN is multi-factorial and attributed, in addition to anti-phospholipid Abs, to complement system activation with C4d staining, inflammatory factors, infections, genetic factors (e.g., HLA-DRB1*13), and drugs [93].…”

Section: Anti-phospholipid Antibodiesmentioning

confidence: 99%

Lupus Nephritis Risk Factors and Biomarkers: An Update

Renaudineau,

Brooks,

Belliere

2023

IJMS

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Lupus nephritis (LN) represents the most severe organ manifestation of systemic lupus erythematosus (SLE) in terms of morbidity and mortality. To reduce these risks, tremendous efforts have been made in the last decade to characterize the different steps of the disease and to develop biomarkers in order to better (i) unravel the pre-SLE stage (e.g., anti-nuclear antibodies and interferon signature); (ii) more timely initiation of therapy by improving early and accurate LN diagnosis (e.g., pathologic classification was revised); (iii) monitor disease activity and therapeutic response (e.g., recommendation to re-biopsy, new urinary biomarkers); (iv) prevent disease flares (e.g., serologic and urinary biomarkers); (v) mitigate the deterioration in the renal function; and (vi) reduce side effects with new therapeutic guidelines and novel therapies. However, progress is poor in terms of improvement with early death attributed to active SLE or infections, while later deaths are related to the chronicity of the disease and the use of toxic therapies. Consequently, an individualized treat-to-target strategy is mandatory, and for that, there is an unmet need to develop a set of accurate biomarkers to be used as the standard of care and adapted to each stage of the disease.

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“…APSN was shown to have poor renal prognosis, with an end-stage stage renal disease-free survival at 5 years of 80%, despite the population of this study was relatively young (average age 40 years). Patients on anticoagulation therapy did not show any benefit on renal outcomes [106]. However, another recent study found that anticoagulation therapy improved kidney outcomes in SLE patients with TMA [107].…”

Section: Aps Nephropathymentioning

confidence: 99%

Antiphospholipid Syndrome and Kidney Involvement

De Simone,

Sciascia,

Fenoglio

et al. 2023

Kidney Blood Press Res

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Background: Antiphospholipid syndrome is an autoimmune disease characterized by the development of autoantibodies and the impairment of the coagulation system. Knowledge about this syndrome is increasing over time, but kidney involvement, especially APS nephropathy, still represents a challenge for physicians. Summary: A “two hit” model has been hypothesized to explain APS pathophysiology, and the role played by some factors, such as the complement system, is becoming more and more clear. From a clinical point of view, along with thrombosis in any site and/or obstetric morbidities, that are the hallmarks of APS, a constellation of several other clinical symptoms is related to APS. These symptoms alone are not sufficient to fulfill Sydney criteria for APS and this could potentially lead to omitting some diagnoses. The mainstay of management of APS is antithrombotic therapy but there are expectations for new drugs that regulate the immune system. APS could affect the kidneys in many ways and among them, APS nephropathy is an intriguing entity that has been overlooked in recent years. Novel studies on APS nephropathy are lacking. Key messages: In this review we discuss what we currently know about APS and its relationship with the kidney, with an eye towards the future perspectives. Multicenter studies on APS nephropathy are necessary in order to develop targeted therapies.

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Renal and vascular outcomes in patients with isolated antiphospholipid syndrome nephropathy

Cited by 5 publications

References 33 publications

Pregnancy as a susceptible state for thrombotic microangiopathies

Pregnancy as a susceptible state for thrombotic microangiopathies

Lupus Nephritis Risk Factors and Biomarkers: An Update

Antiphospholipid Syndrome and Kidney Involvement

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