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Clinical Reviews in Allergy & Immunology

Published in:

01-06-2009

Renal Involvement in the Antiphospholipid Syndrome (APS)—APS Nephropathy

Author: Maria G. Tektonidou

Published in: Clinical Reviews in Allergy & Immunology | Issue 2-3/2009

Abstract

Although the kidney represents a major target organ in antiphospholipid syndrome (APS), renal involvement in APS was poorly recognized until recently. The most well-recognized renal manifestations of APS are the renal artery thrombosis/stenosis, renal infarction, hypertension, renal vein thrombosis, end-stage renal disease, increased allograft vascular thrombosis, some types of glomerular disease, and a small-vessel vaso-occlusive nephropathy, recently defined as APS nephropathy. APS nephropathy was first described in primary APS patients, characterized by acute thrombotic lesions in glomeruli and/or arterioles (thrombotic microangiopathy) and chronic vascular lesions such as fibrous intimal hyperplasia of arterioles and interlobular arteries, organized thrombi with or without recanalization, and fibrous arterial and arteriolar occlusions or focal cortical atrophy. APS nephropathy was also detected in further studies including patients with systemic lupus erythematosus (SLE)-related APS and SLE/non-APS patients with positive antiphospholipid antibodies, independently of lupus nephritis. The same histologic lesions, especially thrombotic mictroangiopathy, were also observed in patients with catastrophic APS. The most frequent clinical and laboratory characteristics of APS nephropathy in all the above groups of patients are hypertension (often severe), proteinuria (ranging from mild to nephrotic range), hematuria, and acute or chronic renal insufficiency.

Wilson WA, Gharavi AE, Koike T et al (1999) International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 42:1309–1311PubMedCrossRef

Miyakis S, Lockshin MD, Atsumi T et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4:295–306PubMedCrossRef

Hughes GR (1993) The antiphospholipid syndrome: ten years on. Lancet 341:342–344CrossRef

Asherson RA, Kant KS (1988) A “primary” antiphospholipid syndrome. J Rheumatol 15:1742–1746PubMed

Cervera R, Piette JC, Font J et al (2002) Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 46:1019–1027PubMedCrossRef

Love PE, Santoro SA (1990) Antiphospholipid antibodies: anticardiolipin and lupus anticoagulant in systemic lupus erythematosus (SLE) and non-SLE disorders. Ann Intern Med J 112:682–689

Harris EN, Gharavi AE, Asherson RA, Boey ML, Hughes GR (1984) Cerebral infarction in systemic lupus: association with anticardiolipin antibodies. Clin Exp Rheumatol 2:47–51PubMed

Ostuni PA, Lazzarin P, Pengo V et al (1990) Renal artery thrombosis and hypertension in a 13 year old girl with antiphospholipid syndrome. Ann Rheum Dis 49:184–187PubMedCrossRef

Asherson RA, Noble GE, Hughes GRV (1991) Hypertension and renal stenosis in the primary antiphospholipid syndrome. J Rheumatol 18:1413–1415PubMed

10.

Ames PR, Cianciaruso B, Belizzi V et al (1992) Bilateral renal artery occlusion in a patient with the primary antiphospholipid syndrome: thrombosis, vasculitis or both? J Rheumatol 10:1802–1806

11.

Rossi E, Sani C, Zini M, Casoli MC, Restori G (1992) Anticardiolipin antibodies and renovascular hypertension. Ann Rheum Dis 51:1180–1181PubMedCrossRef

12.

Mandreoli M, Zuccala A, Zucchelli P (1992) Fibromuscular dysplasia of the renal arteries associated with antiphospholipid autoantibodies: two cases reports. Am J Kidney Dis 20:500–503PubMed

13.

Mandreoli M, Zucchelli P (1993) Renal vascular disease in patients with primary antiphospholipid autoantibodies. Nephrol Dial Transplant 8:1277–1280PubMed

14.

Poux JM, Boudet R, Lacroix P et al (1996) Renal infarction and thrombosis of the infrarenal aorta in 35 year-old man with primary antiphospholipid syndrome. Am J Kidney Dis 27:721–725PubMedCrossRef

15.

Godfrey T, Khamashta MA, Hughes GRV (2000) Antiphospholipid syndrome and renal artery stenosis. QJM 93:127–129PubMedCrossRef

16.

Sangle SR, D’ Cruz DP, Jan W et al (2003) Renal artery stenosis in the antiphospholipid syndrome (Hughes) syndrome and hypertension. Ann Rheum Dis 62:999–1002PubMedCrossRef

17.

Remondino GI, Mysler E, Pissano MN et al (2000) A reversible bilateral renal artery stenosis in association with antiphopsholipid syndrome. Lupus 9:65–67PubMedCrossRef

18.

Sangle SR, D’ Cruz DP, Abbs IC, Khamashta MA, Hughes GR (2005) Renal artery stenosis in hypertensive patients with antiphospholipid syndrome (Hughes syndrome): outcome following anticoagulation. Rheumatology (Oxford) 44:372–377CrossRef

19.

Rysana R, Zabka J, Peregin JH, Tesar V, Merta M, Rychlik I (1998) Acute renal failure due to bilateral renal artery thrombosis associated with primary antiphospholipid syndrome. Nephrol Dial Transplant 13:2645–2647CrossRef

20.

Aizawa K, Nakamura T, Sumino H et al (2000) Renovascular hypertension observed in a patient with antiphospholipid-antibody syndrome. Jpn Circ J 64:541–543PubMedCrossRef

21.

Peribasekar S, Chawla K, Rosner F, Depestre M (1995) Complete recovery from renal infarcts in a patient with mixed connective tissue disease. Am J Kidney Dis 26:649–653CrossRef

22.

Sonpal GM, Sharma A, Miller A (1993) Primary antiphospholipid antibody syndrome, renal infarction and hypertension. J Rheumatol 20:1221–1223PubMed

23.

Hughes G (1984) Connective tissue diseases and the skin. The 1983 Posser–White Oration. Clin Exp Dermatol 9:535–544PubMedCrossRef

24.

Hughes GRV, Harris EN, Gharavi AE (1987) The anticardiolipin syndrome. J Rheumatol 13:486–489

25.

Asherson RA, Lanham JG, Hull RG et al (1984) Renal vein thrombosis in systemic lupus associated with the lupus anticoagulant. Clin Exp Rheumatol 2:47–51PubMed

26.

Jouquan J, Pennec Y, Mottier D et al (1986) Accelerated hypertension associated with lupus anticoagulant and false positive VDRL in systemic lupus erythematosus. Arthritis Rheum 29:147PubMedCrossRef

27.

Cacoub P, Piette JC, Beaufilis H et al (1992) Malignant hypertension in the antiphospholipid syndrome (APS) without lupus nephritis (abst). Arthritis Rheum 35:S360

28.

Kincaid-Smith P, Fairley KF, Kloss M (1988) Lupus anticoagulant associated with renal thrombotic microangiopathy and pregnancy-related renal failure. Q J Med 68:795–815PubMed

29.

Julkunen H, Kaaja R, Jouhikainen T et al (1991) Malignant hypertension and antiphospholipid antibodies as presenting features of SLE in a young woman using oral contraceptives. Br J Rheumatol 30:471–472PubMedCrossRef

30.

Nochy D, Daugas E, Droz D et al (1999) The intrarenal vascular lesions associated with primary antiphospholipid syndrome. J Am Soc Nephrol 10:507–518PubMed

31.

Daugas E, Nochy D, Huong du LT et al (2002) Antiphospholipid syndrome nephropathy in systemic lupus erythematosus. J Am Soc Nephrol 13:42–52PubMedCrossRef

32.

Tektonidou MG, Sotsiou F, Nakopoulou L, Vlachoyiannopoulos PG, Moutsopoulos HM (2004) Antiphospholipid syndrome nephropathy in patients with systemic lupus erythematosus and antiphospholipid antibodies: prevalence, clinical associations, and long-term outcome. Arthritis Rheum 50:2569–2579PubMedCrossRef

33.

Tektonidou MG, Sotsiou F, Moutsopoulos HM (2008) Antiphospholipid syndrome (APS) nephropathy in catastrophic, primary and systemic lupus erythematosus-related APS. J Rheumatol 35:1983–1988PubMed

34.

Dayal NA, Isenberg DA (2003) End stage renal failure in primary antiphospholipid syndrome-case report and review of literature. Rheumatology (Oxford) 42:1128–1129CrossRef

35.

Asherson MA, Khamashta MA, Hughes GRV (1993) Hypertension and the antiphospholipid antibodies. Clin Exp Rheumatol 11:465–467PubMed

36.

Glueck HI, Kant KS, Weiss MA, Pollak VE, Miller MA, Coots M (1985) Thrombosis in systemic lupus erythematosus. Relation to the presence of circulating anticoagulants. Arch Intern Med 145:1389–1395PubMedCrossRef

37.

D’Cruz DP (2005) Renal manifestations of the antiphospholipid syndrome. Lupus 14:45–48PubMedCrossRef

38.

Lai NS, Lan JL (1997) Renal vein thrombosis in Chinese patients with systemic lupus erythematosus. Ann Rheum Dis 56:562–564PubMedCrossRef

39.

Mintz G, Acevedo-Vazquez E, Guttierrez-Espinosa G et al (1984) Renal vein thrombosis and inferior vena cava thrombosis in systemic lupus erythematosus. Arthritis Rheum 27:539–544PubMedCrossRef

40.

Piette JC, Cacoub P, Wechsler B (1994) Renal manifestations of the antiphospholipid syndrome. Semin Arthritis Rheum 23:357–366PubMedCrossRef

41.

Garcia-Martin F, De Arriba G, Carrascosa T et al (1991) Anticardiolipin antibodies and lupus anticoagulant in end stage renal disease. Nephrol Dial Transplant 6:543–547PubMed

42.

Quereda C, Pardo A, Lamas S et al (1988) Lupus-like in vitro anticoagulant activity in end-stage renal disease. Nephron 49:39–44PubMedCrossRef

43.

Gronhagen-Riska C, Teppo AM, Healntera A et al (1990) Raised concentrations of antibodies to cardiolipin in patients receiving dialysis. BMJ 300:1696–1697PubMed

44.

Brunet P, Aillaud MF, SanMarco M et al (1995) Antiphospholipid in hemodialysis patients: relationship between lupus anticoagulant and thrombosis. Kidney Int 58:794–800CrossRef

45.

Pieto LN, Suki WN (1994) Frequent hemodialysis graft thrombosis: association with antiphospholipid antibodies. Am J Kidney Dis 23:587–590

46.

Sitter T, Spannagl M, Schiff H (1992) Anticardiolipin antibodies and lupus anticoagulant in patients treated with different methods of renal replacement therapy in comparison to patients with systemic lupus erythematosus. Ann Hematol 65:79–82PubMedCrossRef

47.

Fastenau DR, Wagenknecht DR, McIntyre JA (1999) Increased incidence of antiphospholipid antibodies in left ventricular assist system recipients. Ann Thorac Surg 68:137–142PubMedCrossRef

48.

Uhtman I, Khamashta M (2006) Antiphospholipid syndrome and the kidneys. Semin Arthritis Rheum 35:360–367CrossRef

49.

Fabrizi F, Sangiorgio R, Pontoriero G et al (1999) Antiphospholipid (aPL) antibodies in end stage renal disease. J Nephrol 12:89–94PubMed

50.

Chew SL, Lins RL, Daelemans R, Zachee P, De Clerck LS, Vermylen J (1992) Are antiphospholipid antibodies clinically relevant in dialysis patients. Nephrol Dial Transpalnt 7:1194–1198

51.

Haviv YS (2000) Association of anticardiolipin antibodies with vascular access occlusion in hemodialysis patients: cause or effect. Nephron 86:447–454PubMedCrossRef

52.

Prakash R, Miller CC, Suki W (1995) Anticardiolipin antibody in patients on maintenance hemodialysis and its association with recurrent arteriovenous graft thrombosis. Am J Kidney Dis 26:347–352PubMedCrossRef

53.

Lesar CJ, Merrick HW, Smith MR (1999) Thrombotic complications resulting from hypercoaguable states in chronic hemodialysis vascular access. J Am Coll Sur 189:73–79CrossRef

54.

Stone JH, Amend WJ, Criswell LA (1998) Outcome of renal transplantation in ninety-seven cyclosporine -era patients with systemic lupus erythematosus and matched controls. Arthritis Rheum 41:1438–1445PubMedCrossRef

55.

Radhakrishnan J, Williams GS, Appel GB et al (1994) Renal transplantation in anticardiolipin anrtibody-positive lupus erythematosus patients. Am J Kidney Dis 23:286–289PubMed

56.

Stone JH, Amend WJC, Criswell LA (1999) Antiphospholipid antibody syndrome in renal transplantation: occurrence of clinical events in 96 consecutive patients with systemic lupus erythematosus. Am J Kidney Dis 34:1040–1047PubMedCrossRef

57.

Nied Prieto L, Suki NW (1994) Frequent hemodialysis graft thrombosis: association with antiphospholipid antibodies. Am J Kidney Dis 23:587–590

58.

Ducloux D, Pellet E, Fournier V, Rebibou JM, Bresson-Vautrin C, Racadot E et al (1999) Prevalence and clinical significance of antiphospholipid antibodies in renal transplant recipients. Transplantation 67:90–93PubMedCrossRef

59.

Moroni G, Tantardini F, Galleli B, Quaglini S, Banfi G, Poli F et al (2005) The long-term prognosis of renal transplantation in patients with lupus nephritis. Am J Kidney Dis 45:901–911CrossRef

60.

Wagenknecht DR, Becker DG, LeFor WM, McIntyre JA (1999) Antiphospholipid antibodies are a risk factor for early renal allograft failure. Transplantation 68:241–246PubMedCrossRef

61.

Montragon-Ramirez G, Bochcchio T, Garcia-Torres R et al (1994) Recurrent renal thrombotic angioplasty after kidney transplantation in two patients with primary antiphospholipid syndrome (PAPS). Clin Transplant 8:93–96

62.

Vaidya S, Wang CC, Gugliuzza C et al (1998) Relative risk of post-transplant renal thrombosis in patients with antiphospholipid antibodies. Clin Transplant 12:439–444PubMed

63.

Vaidya S, Gugliuzza K, Daller J (2004) Efficacy of anticoagulation therapy in end-stage renal disease patients with antiphospholipid antibody syndrome. Transplantation 77:1046–1049PubMedCrossRef

64.

Kleinknecht D, Bobrie G, Meyer O, Noel LH, Callard P, Ramdane M (1989) Recurrent thrombosis and renal vascular disease in patients with a lupus anticoagulant. Nephrol Dial Transplant 4:854–858PubMed

65.

Becquemont L, Thervent E, Rondeau E, Lacave R, Mougenot B, Sraer JD (1990) Systemic and renal fibrinolytic activity in a patient with anticardiolipin syndrome and renal thrombotic microangiopathy. Am J Nephrol 10:254–258PubMedCrossRef

66.

D’Agati V, Kunis C, Williams G, Appel GB (1990) Anti-cardiolipin antibody and renal disease: a report of three cases. J Am Soc Nephrol 1:777–784PubMed

67.

Amigo MC, Garcia-Torres R, Robles M, Biochicchio T, Reyes PA (1992) Renal involvement in primary antiphospholipid syndrome. J Rheumatol 19:1181–1185PubMed

68.

Magil AB, McFadden D, Rae A (1986) Lupus glomerulonephritis with thrombotic microangiopathy. Hum Pathol 17:192–194PubMedCrossRef

69.

Domrongkitchaiporn S, Cameron EJ, Jetha N, Kassen BO, Sutton RA (1994) Renal microangiopathy in the primary antiphospholipid syndrome: a case report with literature review. Nephron 68:128–132PubMedCrossRef

70.

Kant KS, Pollak VE, Weiss MA, Glueck HI, Miller MA, Hess EV (1981) Glomerular thrombosis in systemic lupus erythematosus. Prevalence and significance. Medicine 60:71–86PubMedCrossRef

71.

72.

Frampton G, Hicks J, Cameron JS (1991) Significance of anti-phospholipid antibodies in patients with lupus nephritis. Kidney Int 39:1225–1231PubMedCrossRef

73.

Farrugia E, Torres VE, Gastineau D, Michet CJ, Holley KE (1992) Lupus anticoagulant in systemic lupus erythematosus: a clinical and renal pathological study. Am J Kidney Dis 20:463–471PubMed

74.

Hughson MD, Nadasdy T, McCarty GA, Sholer C, Min KW, Silva F (1992) Renal thrombotic microangiopathy in patients with systemic lupus erythematosus and the antiphospholipid syndrome. Am J Kidney Dis 20:150–158PubMed

75.

Bridoux F, Vrtovsnik F, Noel C, Saunier P, Mougenot B, Lemaitre V, Dracon M, Lelievre G, Vanhille P (1998) Renal thrombotic microangiopathy in systemic lupus erythematosus: clinical correlations and long-term renal survival. Nephrol Dial Transplant 13:298–304PubMedCrossRef

76.

Perez RE, McClendon JR, Lie JT (1992) Primary antiphospholipid syndrome with multiorgan arterial and venous thrombosis. J Rheumatol 19:1289–1292PubMed

77.

Lie JT (1996) Pathology of the antiphospholipid syndrome. In: Asherson RA, Cervera R, Piette JC, Shoenfeld Y (eds) The Antiphospholipid syndrome. CRC, Boca Raton, FL, pp 89–104

78.

Salmon JE, de Groot PG (2008) Pathogenetic role of antiphospholipid antibodies. Lupus 17:405–411PubMedCrossRef

79.

Salmon JE, Girardi G, Lockshin MD (2007) The antiphospholipid syndrome as a disorder initiated by inflammation: implications for the therapy of pregnant patients. Nat Clin Pract Rheumatol 3:140–147PubMedCrossRef

80.

Oku K, Atsumi T, Bohgaki M et al (2008) Complement activation in patients with primary antiphospholipid syndrome. Ann Rheum Dis (in press) July 14

81.

Olguin L, Calleja C, Hernandez C et al (2003) Primary antiphospholid antiphospholipid syndrome nephropathy despite anticoagulant therapy. Arthritis Rheum 48(suppl):S359

82.

Hamidou MA, Moreau A, Jego P et al (1995) Captopril and aspirin in the treatment of renal microangiopathy in primary antiphospholipid syndrome. Am J Kidney Dis 25:486–488PubMedCrossRef

83.

Korkmaz C, Kabukcuoglu S, Isiksoy S et al (2003) Renal involvement in primary antiphospholipid syndrome and its response to immunosuppressive therapy. Lupus 12:760–765PubMedCrossRef

84.

Wilkowski M, Arroyo R, McCabe K (1990) Glomerulonephritis in a patient with anticardiolipin antibody. Am J Kidney Dis 15:184–186PubMed

85.

Saracino A, Ramunni A, Pannarale G et al (2005) Kidney disease associated with primary antiphospholipid ssyndrome: clinical signs and histopathological features in an experience of five cases. Clin Nephrol 63:471–476PubMed

86.

Fakhouri F, Noel LH, Zuber J et al (2003) The expanding spectrum of renal diseases associated with antiphospholipid syndrome. Am J Kidney Dis 41:1205–1211PubMedCrossRef

87.

Kant KS, Pollak VE, Weiss MA, Glueck HI, Miller MA, Hess EV (1981) Glomerular thrombosis in systemic lupus erythematosus. Prevalence and significance. Medicine 60:71–86PubMedCrossRef

88.

Leaker B, McGregor A, Griffiths M, Snaith M, Neild GH, Isenberg D (1991) Insidious loss of renal function in patients with anticardiolipin antibodies and absence of overt nephritis. Br J Rheumatol 30:422–425PubMedCrossRef

89.

Mayer SA, Aledort LM (2005) Thrombotic microangiopathy: differential diagnosis, pathophysiology and therapeutic strategies. Mt Sinai J Med 72:166–175PubMed

90.

Cecere FA, Yoshinoya S, Pope RM (1981) Fatal thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus. Relationship to circulating immune complexes. Arthritis Rheum 24:550–553PubMedCrossRef

91.

Bandari S, Harnden P, Brownjohn AM, Turney JH (1998) Association of anticardiolipin antibodies with intraglomerular thrombi and renal dysfunction in lupus nephritis. QJM 91:401–409CrossRef

92.

Moroni G, Ventura D, Riva P et al (2004) Antiphospholipid antibodies are associated with an increased risk for chronic renal insufficiency in patients with lupus nephritis. Am J Kidney Dis 43:28–36PubMedCrossRef

93.

Banfi G, Bertani T, Boeri V, Faraggiana T, Mazzucco G, Monga G et al (1991) Renal vascular lesions as a marker for poor prognosis in patients with lupus nephritis. Am J Kidney Dis 18:240–248PubMed

94.

Miranda JM, Garcia-Torres R, Jara LJ et al (1994) Renal biopsy in systemic lupus erythematosus: significance of glomerular thrombosis. Analysis of 108 cases. Lupus 3:25–29PubMedCrossRef

95.

Asherson RA (1992) The catastrophic antiphospholipid syndrome. J Rheumatol 19:508–512PubMed

96.

Bucciarelli S, Espinosa G, Cervera R et al (2006) European Forum on Antiphospholipid Antibodies. Mortality in the catastrophic antiphospholipid syndrome: causes of death and prognostic factors in a series of 250 patients. Arthritis Rheum 54:2568–2576PubMedCrossRef

97.

Erkan D, Cervera R, Asherson RA (2003) Catastrophic antiphospholipid syndrome. Where do we stand. Arthritis Rheum 48:3320–3327PubMedCrossRef

98.

Inam S, Sidki K, Al-Marshedy AR, Judzewitsch R (1991) Addison’s disease, hypertension, renal and hepatic microthrombosis in “primary” antiphospholipid syndrome. Postgrad Med J 66:385–388CrossRef

99.

Perez RE, McClendon JR, Lie JT (1992) Primary antiphospholipid syndrome with multiorgan arterial and venous thromboses. J Rheumatol 19:1289–1292PubMed

100.

Lacueva J, Enriquez R, Cabezuelo JB, Arenas MD, Teruel A, Gonzalez C (1993) Acute renal failure as first clinical manifestation of the primary antiphospholipid syndrome. Nephron 64:479–480PubMedCrossRef

101.

Peddi VR, Kant KS (1995) Catastrophic secondary antiphospholipid syndrome with concomitant antithrombin III deficiency. J Am Soc Nephrol 5:1882–1887PubMed

102.

Tsirpanlis G, Moustakas G, Sakka E, Triantafyllis G, Sotsiou F, Liapis H et al (2005) Catastrophic antiphospholipid syndrome in a 14-year-old child. Pediatr Nephrol 20:519–521PubMedCrossRef

103.

Sharma J, Karthik S, Rao S, Phadke K, Crasta J, Garg I (2005) Catastrophic antiphospholipid syndrome. Pediatr Nephrol 20:998–999PubMedCrossRef

Title: Renal Involvement in the Antiphospholipid Syndrome (APS)—APS Nephropathy
Author: Maria G. Tektonidou
Publication date: 01-06-2009
Publisher: Humana Press Inc
Published in: Clinical Reviews in Allergy & Immunology / Issue 2-3/2009
Print ISSN: 1080-0549
Electronic ISSN: 1559-0267
DOI: https://doi.org/10.1007/s12016-008-8112-z

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