[Renovascular hypertension associated with antiphospholipid antibodies in a woman with systemic lupus erythematosus].
Systemic lupus erythematosus (SLE) patients, especially those with antiphospholipid antibodies, have a high incidence of arterial and venous thrombotic manifestations. However, renovascular hypertension (RVH) has been rarely reported in these patients. We describe here a 49-year-old female with antiphospholipid antibodies, complicated with RVH and presenting with sudden onset of severe hypertension, headache and nausea. She had experienced phlebitis and arterial thrombosis of the right leg. At the age of 38 years, she was diagnosed as SLE and steroid therapy was started, but she had poor drug compliance and irregularly visited our clinic. On admission, hypertension was recognized and abdominal bruit was audible on physical examination. Serological findings were compatible with SLE. She was also found to have IgG anti-cardiolipin antibody and lupus anticoagulant. Peripheral plasma renin activity (PRA) was elevated, and captopril test showed hyper-response of PRA with lowering of blood pressure. Renal echography and scintigram showed a small and poorly perfused right kidney. Selective angiography demonstrated a severe stenosis of the right renal artery at origin. A stenosis at the origin of both the superior mesenteric artery (SMA) and celiac trunk was also detected. Percutaneous transluminal angioplasty was performed, achieving successful dilatation of the right renal artery and SMA, whereas the attempt to insert the catheter into the celiac trunk was unsuccessful. After this procedure, abdominal bruit has not been audible. Following the initiation of steroid pulse therapy combined with heparin and dipyridamole, her blood pressure was gradually depressed and the test for lupus anticoagulant became negative. Therefore, RVH of this patient is thought to be associated with antiphospholipid antibodies.
Second Department of Internal Medicine University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
R
R
Serino
A
A
Osajima
K
K
Hiroshige
H
H
Anai
H
H
Tanaka
N
N
Kabashima
M
M
Tamura
K
K
Segawa
M
M
Takasugi
A
A
Kuroiwa
D017152:Antibodies, Antiphospholipid / Q000097:blood*; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology; D017538:Mesenteric Artery, Superior; D008641:Mesenteric Vascular Occlusion / Q000209:etiology; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000209:etiology
D017152:Antibodies, Antiphospholipid