Antiphospholipid Syndrome and the Kidney

Patients with the antiphospholipid syndrome may develop venous or arterial thrombosis, and recurrent fetal loss.

This disorder may be associated with systemic disorders such as systemic lupus erythemaatosus or other autoimmune diseases, certain infections, and drugs, or it may occur alone as a primary disease. It is associated with a false-positive result of a Venereal Disease Research Laboratory(VDRL) test, lupus anticoagulants, or anticardiolipin antibodies.

Patients on dialysis or renal transplant patients have an increased risk of thrombosis. Renal involvement is associated with vascular occlusive disease affecting renal blood vessels, ranging from the main renal artery to glomerular capillaries. The findings of glomerular microthrombi similar to those seen in HUS have been seen. Some patients have mild proteinuria with normal renal function, whereas others develop acute or rapidly progressive renal failure associated with proteinuria and an active urinary sediment. Large renal artery thrombosis with renal infarction may be associated with flank pain, hematuria, and worsening renal function. Renal vein thrombosis may be silent and a or acute and associated with flank pain and acute renal TAB dysfunction. to Antiphospholipid antibodies may occur in patients treated with hemodialysis or after renal transplantation. Increased incidence of thrombotic events has been reported in hemodialysis patients. Treatment with warfarin can be successful in reducing the incidence of clotting of an arteriovenous graft.

Antiphospholipid antibodies are associated with an increased incidence of renal allograft thrombosis and loss. Treatment with anticoagulants may prevent recurrence of thrombosis and loss of the renal allograft. Treatment of antiphospholipid syndrome is the same independent of the presence of renal involvement. A patient with thrombotic or thrombosis of a small or larger artery requires anticoagulation to prevent vascular injury.

High-intensity anticoagulation with warfarin(international normalized ratio markedly reduces the incidence of thrombotic events in these patients. agents are not successful in the treatment of this syndrome.