title: A 3-year follow-up of a patient with acute renal failure caused by thrombotic microangiopathy related to antiphospholipid syndrome: case report.
abstract: Background Microvascular manifestations of antiphospholipid antibody syndrome in the kidneys include acute renal failure, thrombotic microangiopathy and hypertension. Therapy has been largely empiric. Case report A 49-year-old Chinese man presented with anuric acute renal failure without abundant proteinuria and heavy haematuria, but markedly low levels of urinary sodium, potassium and chlorine upon admission. On day 1 of hospitalization, his thrombocytopenia, anaemia and renal failure showed rapid progression. The presence of lupus anticoagulant and vascular ischaemia of the small vessels in renal arteriography were also observed. Anticoagulants, continuous renal replacement therapy, glucocorticoids and six sessions of plasma exchange were started. After the fourth plasma exchange (on day 20), his urine output increased and began to normalize. On day 25, haemodialysis was stopped and his general condition gradually improved. A renal biopsy was subsequently performed, and the histopathological diagnosis was thrombotic microangiopathy due to antiphospholipid antibody syndrome. A further 3-year follow-up showed that his haemoglobin level, platelet count and serum creatinine were within the normal range, with stable blood pressure. Conclusion Treatment modalities such as anticoagulation, immunosuppression and plasma exchange are likely to be necessary when severe acute renal failure combined with thrombotic microangiopathy present in nephropathy of antiphospholipid antibody syndrome.
authors.affiliation: Renal Division, Peking University Institute of Nephrology, Beijing, China.
authors.forename: X-J
authors.initials: XJ
authors.lastname: Zhou
authors.affiliation: Renal Division, Peking University Institute of Nephrology, Beijing, China.
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.affiliation: Renal Division, Peking University Institute of Nephrology, Beijing, China.
authors.forename: S-X
authors.initials: SX
authors.lastname: Wang
authors.affiliation: Renal Division, Peking University Institute of Nephrology, Beijing, China.
authors.forename: F-D
authors.initials: FD
authors.lastname: Zhou
authors.affiliation: Renal Division, Peking University Institute of Nephrology, Beijing, China.
authors.forename: M-H
authors.initials: MH
authors.lastname: Zhao
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications*; D018450:Disease Progression; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods; D006435:Renal Dialysis / Q000379:methods; D057049:Thrombotic Microangiopathies / Q000150:complications* / Q000175:diagnosis / Q000209:etiology
chemical_list: D000925:Anticoagulants; D005938:Glucocorticoids; D016682:Lupus Coagulation Inhibitor
keywords: Acute renal failure; antiphospholipid syndrome; thrombotic microangiopathy