Antiphospholipid syndrome nephropathy in systemic lupus erythematosus.
In the course of the antiphospholipid syndrome (APS), the existence of vaso-occlusive lesions capable of affecting numerous organs is now well established. The renal involvement attributable to primary APS, APS nephropathy (APSN), corresponds to vaso-occlusive lesions of the intrarenal vessels, associating side-by-side, acute thromboses with chronic arterial and arteriolar lesions, leading to zones of cortical ischemic atrophy. A retrospective study of 114 lupus patients undergoing renal biopsy was undertaken to determine the following: (1) if APSN can be found in the course of systemic lupus erythematosus (SLE); (2) if certain clinical and biologic factors can permit the prediction of the presence of APSN; and (3) if APSN is a superadded renal morbidity factor in lupus patients. This study shows the following: (1) APSN occurs in SLE (32% of patients with renal biopsies) in addition to, and independently of, lupus nephritis; (2) APSN is statistically associated with lupus anticoagulant but not with anticardiolipin antibodies; (3) APSN is associated with extrarenal APS, mainly arterial thromboses and obstetrical fetal loss, but not with the venous thromboses of APS; (4) APSN is an independent risk factor, over and above lupus nephritis, that contributes to an elevated prevalence of hypertension, elevated serum creatinine, and increased interstitial fibrosis. Thus, it seems likely that, because of its associations with hypertension, elevated serum creatinine, and increased interstitial fibrosis, APSN may worsen the prognosis in these patients. APSN may also have therapeutic significance in that its recognition should permit a better balance between immunosuppressor and antithrombotic and/or vasoprotective therapy. Finally, this study suggests that APSN should be considered as an element to be included in the classification criteria of APS.
Daugas
Eric
E
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Nochy
Dominique
D
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Huong
Du Le Thi
DLT
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Duhaut
Pierre
P
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Beaufils
Hélène
H
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Caudwell
Valérie
V
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Bariety
Jean
J
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Piette
Jean-Charles
JC
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Hill
Gary
G
*Service d'Anatomie Pathologique, Service de Néphrologie et Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Broussais, Paris, France; Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; and INSERM U423, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
D000293:Adolescent; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D005260:Female; D005831:Genital Diseases, Female / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007674:Kidney Diseases / Q000209:etiology*; D007678:Kidney Glomerulus; D016682:Lupus Coagulation Inhibitor / Q000032:analysis; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008181:Lupus Nephritis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology
D016682:Lupus Coagulation Inhibitor; D003404:Creatinine