Recurrent thrombosis and renal vascular disease in patients with a lupus anticoagulant

Nephrol Dial Transplant. 1989;4(10):854-8. doi: 10.1093/ndt/4.10.854.

Abstract

In five patients suffering from recurrent thrombosis and/or fetal death, a lupus anticoagulant was associated with a renal vasculopathy. Ischaemic episodes also involved the skin, heart, eyes and/or central nervous system. All patients were hypertensive. Two had renal insufficiency, two had non-nephrotic proteinuria, and in the last patient renal cortical ischaemia was detected by a tomographic scan in the absence of proteinuria. Renal biopsy showed thrombosis and/or intimal fibrosis of intrarenal vessels, and normal or ischaemic glomeruli without proliferative lesions. High-titres of anticardiolipin antibodies were found in 3 of 3 cases, and persisted after steroid therapy even if the circulating anticoagulant factor disappeared. All patients received corticosteroid therapy, alone or in combination with immunosuppressive drugs; two patients had prolonged oral anticoagulation, but thrombotic episodes recurred after stopping the drug. One patient died; the remaining four survived 18 months to 11 years after diagnosis, with stable chronic renal insufficiency in one of them. These results show that a lupus anticoagulant may be associated with prominent renal vascular disease, in the absence of proliferative glomerular lesions, and suggest that continuous anticoagulation may be beneficial in these patients.

MeSH terms

  • Adult
  • Blood Coagulation Disorders / metabolism*
  • Blood Coagulation Factors / immunology*
  • Blood Coagulation Factors / metabolism
  • Female
  • Fibrosis
  • Follow-Up Studies
  • Humans
  • Kidney Glomerulus / metabolism
  • Kidney Glomerulus / pathology
  • Kidney Tubules / metabolism
  • Kidney Tubules / pathology
  • Lupus Coagulation Inhibitor
  • Male
  • Middle Aged
  • Recurrence
  • Renal Artery / metabolism*
  • Renal Artery / pathology
  • Thrombophlebitis / pathology
  • Thrombosis / metabolism*
  • Thrombosis / pathology

Substances

  • Blood Coagulation Factors
  • Lupus Coagulation Inhibitor