Renal Infarction in a Severely Hypertensive Patient with Lupus erythematosus and Antiphospholipid Antibodies

Abstract

Systemic lupus erythematosus (SLE) patients, specially those with antiphospholipid antibodies, have a high incidence of arterial and venous thrombotic manifestations. However, renal infarction has been rarely reported in these patients. The case of a young female with renal infarction, diagnosed by renal arteriography and scintigraphy, and arterial hypertension (AH) is described. In subsequent years she also suffered several cerebrovascular accidents with important neurological sequelae. No evidence of systemic disease was observed at this time. Fourteen years after the renal infarction a diagnosis of SLE was established. Despite therapy with prednisone, acetylsalicylic acid, azathioprine and antihypertensive drugs the progression of the neurological disease led to death. The sudden appearance of severe AH in a young woman with a renal infarction should alert the clinician about a possible underlying renal artery thrombosis in association with SLE and antiphospholipid antibodies.

Lupus Vasculopathy Combined with Renal Infarction: Unusual Manifestation of Lupus Nephritis

“…Renal infarction has been reported to develop in SLE patients with positive anti-phospholipid antibodies or lupus anticoagulant (12,13). To our knowledge, ours is the first case of lupus vasculopathy causing renal infarction in a SLE patient.…”

Renal infarction in a child with systemic lupus erythematosus

“…There was no family history of SLE and no ingestion of drugs predisposing to renal infarction. Coagulation studies revealed factor VIII 90.21% (normal range 70%-150%), factor V 83.81% (normal range 70%-140%), von Willebrand factor 93.55% (normal 50%-150%), prothrombin time 10 Immunoglobulin studies revealed IgA 1.61 g/l, IgG 14.22, and IgM 0.96 g/l; C3 was 1.1 g/l and C4 0.45 g/l; hepatitis B serology was negative. Valvular anomalies as an underlying risk factor were excluded by normal echocardiography.…”

Kidney Disease in Antiphospholipid Syndrome

“…Bilateral renal artery stenosis/thrombosis resulted in a poorly perfused kidney and cortical irregularities were present in the contralateral kidney. Hernández et al [5] reported on a young woman with sudden, severe hypertension and a renal infarction who, 14 years later, developed SLE. Asherson et al [6] described a young man with PAPS, arterial hypertension, and a right renal artery stenosis with renal infarction which was thought to be caused by thrombotic occlusion.…”

“…In the presence of aPL, renal infarctions result from partial or total, transient or permanent occlusion of renal arteries [4,5,8,9,15,16]. Such occlusion may be caused by diverse mechanisms such as in situ thrombosis/stenosis of a renal artery or an embolic event originating on a verrucous cardiac valve.…”

“…Nephrectomy, with subsequent normalization of blood pressure and secondary aldosteronism, was performed in 1 patient because the kidney was seriously and irreversibly damaged [14]. However, adverse outcomes may occur [5]. The sooner an arterial lesion causing arterial hypertension is relieved, the likelier a successful outcome.…”