Systemic and renal fibrinolytic activity in a patient with anticardiolipin syndrome and renal thrombotic microangiopathy.
A 24-year-old white woman with a past history of recurrent venous thromboses of the lower extremities was admitted for hypertension and renal failure. She had a chronic cutaneous ulcer on the anterior side of the left leg and oral ulcers of the palatum. Laboratory tests demonstrated rapidly progressive renal failure and the presence of an anticardiolipin antibody (ELISA). Thrombosis of the inferior vena cava was shown by phlebocavography. Renal biopsy revealed typical thrombotic microangiopathy. Tissue-type plasminogen activator (tPA) was visualized by immunofluorescence in endothelial cells of renal arterioles and glomeruli. Normal plasma levels of tPA, urokinase and plasminogen activator inhibitor 1 were found by ELISA, and tPA antigen levels rose after desmopressin acetate infusion. Thus, in this case, the diffuse thrombotic process was not related to defective circulating or renal fibrinolytic systems and could be promoted by the procoagulant effect of antiphospholipid antibodies.
Becquemont
L
L
Service de Néphrologie, Hôpital Tenon, Paris, France.
Thervet
E
E
Rondeau
E
E
Lacave
R
R
Mougenot
B
B
Sraer
J D
JD
D000328:Adult; D001323:Autoantibodies / Q000032:analysis*; D001706:Biopsy; D001779:Blood Coagulation Factors / Q000032:analysis / Q000276:immunology; D002308:Cardiolipins / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016682:Lupus Coagulation Inhibitor; D012078:Renal Artery Obstruction / Q000097:blood*; D013577:Syndrome; D013927:Thrombosis / Q000097:blood*; D010959:Tissue Plasminogen Activator / Q000032:analysis; D014682:Vena Cava, Inferior
D001323:Autoantibodies; D001779:Blood Coagulation Factors; D002308:Cardiolipins; D016682:Lupus Coagulation Inhibitor; D010959:Tissue Plasminogen Activator