title: Renal cortical necrosis related to paraneoplastic antiphospholipid syndrome.
abstract: Acute bilateral renal cortical necrosis is a very rare cause of acute renal failure. We report here for the first time a case related to antiphospholipid syndrome, paraneoplastic of a lung neoplasia. A 46-year-old male smoker without medical history was admitted for acute dyspnea and anuria. Biological examination showed acute renal failure associated with hyperkalemia, high serum lactate dehydrogenase level, and prolonged activated thrombin time (ratio 1.29). Chest radiograph showed a right laterotracheal round lesion. A percutaneous left renal biopsy showed cortical necrosis, and renal arteriography confirmed bilateral cortical necrosis. Blood examination showed antiphospholipid antibodies type anticardiolipin. Chest computed tomographic scan confirmed the presence of a lung tumor. Two years after tumor surgery, the patient was still anuric and on long-term hemodialysis therapy, but antiphospholipid antibody results were negative. This case describes the first association of antiphospholipid syndrome to epidermoid lung cancer, shown by cortical bilateral necrosis. It also emphasizes the utility of renal biopsy in case of an unusual acute renal failure.
authors.affiliation: Intensive Care Unit, St Antoine Hospital, Paris, France. cecile.vigneau@mssm.edu
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.forename: Eric
authors.initials: E
authors.lastname: Daugas
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
authors.forename: Harry
authors.initials: H
authors.lastname: Sokol
authors.forename: Georges
authors.initials: G
authors.lastname: Offenstadt
authors.forename: Jerome
authors.initials: J
authors.lastname: Rossert
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D001002:Anuria / Q000150:complications / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D004417:Dyspnea / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007673:Kidney Cortex Necrosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008175:Lung Neoplasms / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D013918:Thrombin Time; D014057:Tomography, X-Ray Computed
chemical_list: D007770:L-Lactate Dehydrogenase