A reversible bilateral renal artery stenosis in association with antiphospholipid syndrome.
We describe a 26-year-old white female with a history of Raynaud phenomenon, erythema nodosum, polyarthralgias, migraine, vertigo, seizures, transient ischemic attacks, one fetal loss, and false positive VDRL, who developed milk hypertension without overt lupus nephritis. She had positive antinuclear antibodies (ANA) and double-stranded deoxyribonucleic acid (dsDNA) antibodies. The lupus anticoagulant test (LAC) and cardiolipins antibodies (aCL) were positive. She was diagnosed as having a Systemic Lupus Erythematosus-like illness (SLE-like) with 'secondary' antiphospholipid syndrome (APS). Renal spiral computed tomography (CT) with intravenous (IV) contrast showed bilateral renal artery stenosis. Anticoagulation with acenocumarol was started. She became normotensive without antihypertensive drugs five months later. A follow-up renal spiral CT showed complete recanalization of both renal arteries, making thrombosis the more likely culprit pathology in the stenosis. After two years follow up the patient is normotensive. She remains on acenocumarol.
Remondino
G I
GI
Autoimmune Diseases Group, Internal Medicine B, Hospital Juan A. Fernández, Buenos Aires, Argentina. groremon@fibertal.com.ar
Mysler
E
E
Pissano
M N
MN
Furattini
M C
MC
Basta
M C
MC
Presas
J L
JL
Allievi
A
A
D000074:Acenocoumarol / Q000627:therapeutic use; D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000032:analysis; D000974:Antibodies, Antinuclear / Q000032:analysis; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D004247:DNA / Q000276:immunology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D016682:Lupus Coagulation Inhibitor / Q000032:analysis; D011928:Raynaud Disease / Q000150:complications; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
D017153:Antibodies, Anticardiolipin; D000974:Antibodies, Antinuclear; D000925:Anticoagulants; D016682:Lupus Coagulation Inhibitor; D004247:DNA; D000074:Acenocoumarol