Recurrent thrombosis and renal vascular disease in patients with a lupus anticoagulant.
In five patients suffering from recurrent thrombosis and/or fetal death, a lupus anticoagulant was associated with a renal vasculopathy. Ischaemic episodes also involved the skin, heart, eyes and/or central nervous system. All patients were hypertensive. Two had renal insufficiency, two had non-nephrotic proteinuria, and in the last patient renal cortical ischaemia was detected by a tomographic scan in the absence of proteinuria. Renal biopsy showed thrombosis and/or intimal fibrosis of intrarenal vessels, and normal or ischaemic glomeruli without proliferative lesions. High-titres of anticardiolipin antibodies were found in 3 of 3 cases, and persisted after steroid therapy even if the circulating anticoagulant factor disappeared. All patients received corticosteroid therapy, alone or in combination with immunosuppressive drugs; two patients had prolonged oral anticoagulation, but thrombotic episodes recurred after stopping the drug. One patient died; the remaining four survived 18 months to 11 years after diagnosis, with stable chronic renal insufficiency in one of them. These results show that a lupus anticoagulant may be associated with prominent renal vascular disease, in the absence of proliferative glomerular lesions, and suggest that continuous anticoagulation may be beneficial in these patients.
Kleinknecht
D
D
Service de Néphrologie et Réanimation Polyvalente, Centre Hospitalier, Montreuik, France.
Bobrie
G
G
Meyer
O
O
Noël
L H
LH
Callard
P
P
Ramdane
M
M
D000328:Adult; D001778:Blood Coagulation Disorders / Q000378:metabolism*; D001779:Blood Coagulation Factors / Q000276:immunology* / Q000378:metabolism; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D007678:Kidney Glomerulus / Q000378:metabolism / Q000473:pathology; D007684:Kidney Tubules / Q000378:metabolism / Q000473:pathology; D016682:Lupus Coagulation Inhibitor; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012077:Renal Artery / Q000378:metabolism* / Q000473:pathology; D013924:Thrombophlebitis / Q000473:pathology; D013927:Thrombosis / Q000378:metabolism* / Q000473:pathology
D001779:Blood Coagulation Factors; D016682:Lupus Coagulation Inhibitor