RECURRENT THROMBOSIS AND RENAL VASCULAR-DISEASE IN PATIENTS WITH A LUPUS ANTICOAGULANT
RECURRENT THROMBOSIS AND RENAL VASCULAR-DISEASE IN PATIENTS WITH A LUPUS ANTICOAGULANT
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DOI：
10.1093/ndt/4.10.854
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发表时间：
1989-01-01
影响因子：
6.1
通讯作者：
RAMDANE, M
中科院分区：
文献类型：
--
作者：
KLEINKNECHT, D;BOBRIE, G;RAMDANE, M
在5例患有复发性血栓形成和/或胎儿死亡的患者中，狼疮抗凝剂与肾血管病变相关。缺血发作还涉及皮肤、心脏、眼睛和/或中枢神经系统。所有患者均为高血压。两个肾功能不全，两个非肾病蛋白尿，并在最后一个病人肾皮质缺血检测到的断层扫描的蛋白尿的情况下。肾活检显示肾内血管血栓形成和/或内膜纤维化，肾小球正常或缺血，无增生性病变。高滴度的抗心磷脂抗体被发现在3例，并持续类固醇治疗后，即使循环抗凝因子消失。所有患者均接受皮质类固醇单独治疗或与免疫抑制药物联合治疗;两名患者长期口服抗凝药物，但停药后血栓形成发作复发。1名患者死亡;其余4名患者在诊断后存活了18个月至11年，其中1名患者患有稳定的慢性肾功能不全。这些结果表明，狼疮抗凝剂可能与突出的肾血管疾病，在没有增生性肾小球病变，并建议持续抗凝可能是有益的，在这些患者。
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 innsufficiency, 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 lupus anticoagulant may be associated with prominent renal vascular disease, in the absence of proliferative glomerular lesionms, and suggest that continuous anticoagulation may be beneficial in these patients.