Antiphospholipid syndrome and the kidney

INTRODUCTION

The antiphospholipid syndrome (APS) is characterized by antibodies directed against either phospholipids or plasma proteins bound to anionic phospholipids. Patients with the APS may display a constellation of clinical features including venous and arterial thrombosis, recurrent fetal losses, and thrombocytopenia. This disorder is referred to as the primary APS when it occurs alone; however, it can also be found in association with systemic lupus erythematosus (SLE), other rheumatic diseases, and with certain infections and drugs.

Four types of antiphospholipid antibodies have been characterized:

  • Antibodies causing a false positive VDRL
  • Lupus anticoagulants
  • Anticardiolipin antibodies
  • Antibodies to beta2-glycoprotein I

There appears to be a relationship between the isotype and titer of antiphospholipid antibody, and the risk of thrombotic events. Higher titers of IgG antiphospholipid antibody, for example, have been reported to be associated with a greater incidence of thrombotic events [1].

The kidney is one of the organs that can be compromised in patients with antiphospholipid antibodies (aPL). Renal complications directly resulting from thrombotic events associated with these antibodies include glomerular disease, large vessel renal involvement, and coagulation problems relating to dialysis and renal transplants [2-8].

             

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: May 17, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Escalante A, Brey RL, Mitchell BD Jr, Dreiner U. Accuracy of anticardiolipin antibodies in identifying a history of thrombosis among patients with systemic lupus erythematosus. Am J Med 1995; 98:559.
  2. Joseph RE, Radhakrishnan J, Appel GB. Antiphospholipid antibody syndrome and renal disease. Curr Opin Nephrol Hypertens 2001; 10:175.
  3. Amigo MC, Garcia-Torres R, Robles M, et al. Renal involvement in primary antiphospholipid syndrome. J Rheumatol 1992; 19:1181.
  4. Kincaid-Smith P, Fairley KF, Kloss M. Lupus anticoagulant associated with renal thrombotic microangiopathy and pregnancy-related renal failure. Q J Med 1988; 68:795.
  5. Farrugia E, Torres VE, Gastineau D, et al. Lupus anticoagulant in systemic lupus erythematosus: a clinical and renal pathological study. Am J Kidney Dis 1992; 20:463.
  6. Sonpal GM, Sharma A, Miller A. Primary antiphospholipid antibody syndrome, renal infarction and hypertension. J Rheumatol 1993; 20:1221.
  7. Asherson RA, Lanham JG, Hull RG, et al. Renal vein thrombosis in systemic lupus erythematosus: association with the "lupus anticoagulant". Clin Exp Rheumatol 1984; 2:75.
  8. Nicholls, K, Kincaid-Smith, P. Antiphospholipid syndrome and renal thrombotic microangiopathy. J Nephrol 1995; 8:123.
  9. Asherson RA, Harris EN. Anticardiolipin antibodies--clinical associations. Postgrad Med J 1986; 62:1081.
  10. D'Agati V, Kunis C, Williams G, Appel GB. Anti-cardiolipin antibody and renal disease: a report three cases. J Am Soc Nephrol 1990; 1:777.
  11. Nochy D, Daugas E, Droz D, et al. The intrarenal vascular lesions associated with primary antiphospholipid syndrome. J Am Soc Nephrol 1999; 10:507.
  12. Griffiths MH, Papadaki L, Neild GH. The renal pathology of primary antiphospholipid syndrome: a distinctive form of endothelial injury. QJM 2000; 93:457.
  13. Aydin Z, Bruijn JA, Vleming LJ. ARF and cerebral infarcts in a young woman. Am J Kidney Dis 2004; 44:179.
  14. Saracino A, Ramunni A, Pannarale G, Coratelli P. Kidney disease associated with primary antiphospholipid syndrome: clinical signs and histopathological features in an case experience of five cases. Clin Nephrol 2005; 63:471.
  15. Nzerue CM, Hewan-Lowe K, Pierangeli S, Harris EN. "Black swan in the kidney": renal involvement in the antiphospholipid antibody syndrome. Kidney Int 2002; 62:733.
  16. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 18-1999. A 54-year-old woman with acute renal failure and thrombocytopenia. N Engl J Med 1999; 340:1900.
  17. Fakhouri F, Noël LH, Zuber J, et al. The expanding spectrum of renal diseases associated with antiphospholipid syndrome. Am J Kidney Dis 2003; 41:1205.
  18. Sinico RA, Cavazzana I, Nuzzo M, et al. Renal involvement in primary antiphospholipid syndrome: retrospective analysis of 160 patients. Clin J Am Soc Nephrol 2010; 5:1211.
  19. Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med 1990; 112:682.
  20. Nast C, Appel G. A case of lupus nephritis. Clin J Am Soc Nephrol 2008; 3:297.
  21. Hughes GR. The antiphospholipid syndrome: ten years on. Lancet 1993; 342:341.
  22. Appel GB, Pirani CL, D'Agati V. Renal vascular complications of systemic lupus erythematosus. J Am Soc Nephrol 1994; 4:1499.
  23. Tektonidou MG, Sotsiou F, Nakopoulou L, et al. Antiphospholipid syndrome nephropathy in patients with systemic lupus erythematosus and antiphospholipid antibodies: prevalence, clinical associations, and long-term outcome. Arthritis Rheum 2004; 50:2569.
  24. Daugas E, Nochy D, Huong DL, et al. Antiphospholipid syndrome nephropathy in systemic lupus erythematosus. J Am Soc Nephrol 2002; 13:42.
  25. Moroni G, Ventura D, Riva P, et al. Antiphospholipid antibodies are associated with an increased risk for chronic renal insufficiency in patients with lupus nephritis. Am J Kidney Dis 2004; 43:28.
  26. Brunet P, Aillaud MF, San Marco M, et al. Antiphospholipids in hemodialysis patients: relationship between lupus anticoagulant and thrombosis. Kidney Int 1995; 48:794.
  27. Prakash R, Miller CC 3rd, Suki WN. Anticardiolipin antibody in patients on maintenance hemodialysis and its association with recurrent arteriovenous graft thrombosis. Am J Kidney Dis 1995; 26:347.
  28. García-Martín F, De Arriba G, Carrascosa T, et al. Anticardiolipin antibodies and lupus anticoagulant in end-stage renal disease. Nephrol Dial Transplant 1991; 6:543.
  29. Prieto LN, Suki WN. Frequent hemodialysis graft thrombosis: association with antiphospholipid antibodies. Am J Kidney Dis 1994; 23:587.
  30. Radhakrishnan J, Williams GS, Appel GB, Cohen DJ. Renal transplantation in anticardiolipin antibody-positive lupus erythematosus patients. Am J Kidney Dis 1994; 23:286.
  31. Khamashta MA, Cuadrado MJ, Mujic F, et al. The management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med 1995; 332:993.
  32. Asherson RA, Khamashta MA, Ordi-Ros J, et al. The "primary" antiphospholipid syndrome: major clinical and serological features. Medicine (Baltimore) 1989; 68:366.
  33. Ducloux D, Pellet E, Fournier V, et al. Prevalence and clinical significance of antiphospholipid antibodies in renal transplant recipients. Transplantation 1999; 67:90.
  34. Kazory A, Ducloux D. Acquired hypercoagulable state in renal transplant recipients. Thromb Haemost 2004; 91:646.
  35. Stone JH, Amend WJ, Criswell LA. Antiphospholipid antibody syndrome in renal transplantation: occurrence of clinical events in 96 consecutive patients with systemic lupus erythematosus. Am J Kidney Dis 1999; 34:1040.
  36. Forman JP, Lin J, Pascual M, et al. Significance of anticardiolipin antibodies on short and long term allograft survival and function following kidney transplantation. Am J Transplant 2004; 4:1786.
  37. Baid S, Pascual M, Williams WW Jr, et al. Renal thrombotic microangiopathy associated with anticardiolipin antibodies in hepatitis C-positive renal allograft recipients. J Am Soc Nephrol 1999; 10:146.
  38. Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med 2003; 349:1133.
  39. Mackworth-Young CG, Loizou S, Walport MJ. Antiphospholipid antibodies and disease. Q J Med 1989; 72:767.
  40. Vaidya S, Sellers R, Kimball P, et al. Frequency, potential risk and therapeutic intervention in end-stage renal disease patients with antiphospholipid antibody syndrome: a multicenter study. Transplantation 2000; 69:1348.
  41. Vaidya S, Gugliuzza K, Daller JA. Efficacy of anticoagulation therapy in end-stage renal disease patients with antiphospholipid antibody syndrome. Transplantation 2004; 77:1046.
  42. Vella J. Significance of anticardiolipin antibodies on short- and long-term allograft survival and function following kidney transplantation. Am J Transplant 2004; 4:1731.
  43. Friedman GS, Meier-Kriesche HU, Kaplan B, et al. Hypercoagulable states in renal transplant candidates: impact of anticoagulation upon incidence of renal allograft thrombosis. Transplantation 2001; 72:1073.
  44. Kaplan AA. The use of apheresis in immune renal disorders. Ther Apher Dial 2003; 7:165.
  45. Sokunbi DO, Miller F, Wadhwa NK, Nord EP. Reversible renal failure in the primary antiphospholipid syndrome--a report of two cases. J Am Soc Nephrol 1993; 4:28.