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Suenaga A, Sawa N, Miki K, Yokoyama T, Ishii Y, Mizuno H, Ikuma D, Oba Y, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Kono K, Kinowaki K, Ohashi K, Honda K, Miyazono M, Nakamura Y, Ubara Y. Antiphospholipid Syndrome Nephropathy with Acute Thrombotic Microangiopathy after Renal Transplantation. Intern Med 2023; 62:2707-2713. [PMID: 36725047 PMCID: PMC10569915 DOI: 10.2169/internalmedicine.0813-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/11/2022] [Indexed: 02/03/2023] Open
Abstract
We experienced a 36-year-old man with lupus nephritis and antiphospholipid syndrome (APS) who received a donor kidney from his father. Twenty-two months after transplantation, at a time of poor adherence to immunosuppressants and warfarin, the patient developed sudden graft loss due to hemolytic uremic syndrome with rapid deterioration of renal function, thrombocytopenia, and hemolytic anemia. A kidney biopsy showed thrombotic microangiopathy (TMA) related to platelet thrombus formation; however, there was no recurrence of lupus and no findings suggestive of post-transplant rejection, so acute TMA associated with APS was thought to be the cause of the graft loss. This case highlights the importance of instructing patients with lupus nephritis to adhere to treatment with warfarin, a therapeutic drug for APS.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Katsuyuki Miki
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Takayoshi Yokoyama
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yasuo Ishii
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, Japan
| | - Motoaki Miyazono
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Yuki Nakamura
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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de Melo Marques SH, Ferreira HAN, de Morais Nunes ATP, Silva RNP, Norton SMMS. Two Faces of the Same Coin: A Case Report of Antiphospholipid Syndrome Nephropathy. Eur J Case Rep Intern Med 2017; 4:000542. [PMID: 30755930 PMCID: PMC6346871 DOI: 10.12890/2017_000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/04/2017] [Indexed: 11/23/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disease which can be primary or secondary to other autoimmune conditions and is defined by the occurrence of arterial or venous thrombosis, or pregnancy morbidity associated with persistently positive antiphospholipid antibodies (aPLA). The kidney may be affected by thrombosis at any level of its vasculature. When small vessels are involved, this results in thrombotic microangiopathy (TMA), which can manifest as either acute vaso-occlusive or chronic vascular lesions in glomeruli, arterioles and interlobular arteries. We report the case of 26-year-old man, with a previous medical history suggestive of APS, who was found to have a small elevation in serum creatinine. A kidney biopsy was performed and revealed features of chronic TMA. Anticoagulation was begun and kidney function remained stable. However, one year later, upon suspension of anticoagulation, the patient developed acute kidney injury and a second kidney biopsy showed acute TMA. This case describes different manifestations of antiphospholipid syndrome nephropathy (APSN) and highlights the importance of anticoagulation for thrombosis prevention.
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