Lupus anticoagulant in systemic lupus erythematosus : a clinical and renal pathological study

Circulating lupus anticoagulant (LA) is associated with thrombosis in large and small vessels. To determine how often the presence of LA is associated with thrombosis within the renal microcirculation, 33 patients with systemic lupus erythematosus (SLE), renal dysfunction, and LA were identified ove...

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Veröffentlicht in:American journal of kidney diseases 1992-11, Vol.20 (5), p.463-471
Hauptverfasser: FARRUGIA, E, TORRES, V. E, GASTINEAU, D, MICHET, C. J, HOLLEY, K. E
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container_end_page 471
container_issue 5
container_start_page 463
container_title American journal of kidney diseases
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creator FARRUGIA, E
TORRES, V. E
GASTINEAU, D
MICHET, C. J
HOLLEY, K. E
description Circulating lupus anticoagulant (LA) is associated with thrombosis in large and small vessels. To determine how often the presence of LA is associated with thrombosis within the renal microcirculation, 33 patients with systemic lupus erythematosus (SLE), renal dysfunction, and LA were identified over a 25-year period (LA group) and 32 patients with renal SLE but with normal gross coagulation screen were matched for age, sex, and biopsy timing (C group). Prevalences of serositis, neuropsychiatric illness, leukopenia, thrombocytopenia, hemolysis, anti-DS-DNA elevation, and complement reduction were similar. Arthritis was less and biologic false-positive (BFP) syphilis serology more common in LA. More LA patients had thrombotic events (LA 39% v C 13%; P = 0.014); bleeding episodes, including postbiopsy, were similar. At biopsy, hypertension (LA 55%, C 41%), serum creatinine (mean +/- SD: LA 186 +/- 168 mumol/L [2.1 +/- 1.9 mg/dL] v C 150 +/- 168 mumol/L [1.7 +/- 1.9 mg/dL]) and proteinuria (LA 2.6 +/- 3.1 g/24 h v C 3.1 +/- 2.7) were similar. Lesions by World Health Organization (WHO) class, activity, and chronicity indices, as well as immunofluorescence (IF) and electron microscopy (EM) findings, were not significantly different. Occlusive glomerular, arteriolar, and arterial fibrin thrombi, along with varying degrees of renal thrombotic microangiopathy, were seen in five of 33 patients with LA, but zero of 32 C patients (P = 0.053); three of these five patients died soon after biopsy. Overall, mortality was not different between LA and C. We conclude that the majority of patients with SLE, renal dysfunction, and LA exhibit renal morphologic findings indistinguishable from patients without LA. However, a significant minority of LA patients have thrombotic microangiopathy in their biopsy, which is accompanied by a worse prognosis.
doi_str_mv 10.1016/S0272-6386(12)70258-5
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At biopsy, hypertension (LA 55%, C 41%), serum creatinine (mean +/- SD: LA 186 +/- 168 mumol/L [2.1 +/- 1.9 mg/dL] v C 150 +/- 168 mumol/L [1.7 +/- 1.9 mg/dL]) and proteinuria (LA 2.6 +/- 3.1 g/24 h v C 3.1 +/- 2.7) were similar. Lesions by World Health Organization (WHO) class, activity, and chronicity indices, as well as immunofluorescence (IF) and electron microscopy (EM) findings, were not significantly different. Occlusive glomerular, arteriolar, and arterial fibrin thrombi, along with varying degrees of renal thrombotic microangiopathy, were seen in five of 33 patients with LA, but zero of 32 C patients (P = 0.053); three of these five patients died soon after biopsy. Overall, mortality was not different between LA and C. We conclude that the majority of patients with SLE, renal dysfunction, and LA exhibit renal morphologic findings indistinguishable from patients without LA. 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E</creatorcontrib><creatorcontrib>GASTINEAU, D</creatorcontrib><creatorcontrib>MICHET, C. J</creatorcontrib><creatorcontrib>HOLLEY, K. E</creatorcontrib><title>Lupus anticoagulant in systemic lupus erythematosus : a clinical and renal pathological study</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description>Circulating lupus anticoagulant (LA) is associated with thrombosis in large and small vessels. To determine how often the presence of LA is associated with thrombosis within the renal microcirculation, 33 patients with systemic lupus erythematosus (SLE), renal dysfunction, and LA were identified over a 25-year period (LA group) and 32 patients with renal SLE but with normal gross coagulation screen were matched for age, sex, and biopsy timing (C group). Prevalences of serositis, neuropsychiatric illness, leukopenia, thrombocytopenia, hemolysis, anti-DS-DNA elevation, and complement reduction were similar. Arthritis was less and biologic false-positive (BFP) syphilis serology more common in LA. More LA patients had thrombotic events (LA 39% v C 13%; P = 0.014); bleeding episodes, including postbiopsy, were similar. At biopsy, hypertension (LA 55%, C 41%), serum creatinine (mean +/- SD: LA 186 +/- 168 mumol/L [2.1 +/- 1.9 mg/dL] v C 150 +/- 168 mumol/L [1.7 +/- 1.9 mg/dL]) and proteinuria (LA 2.6 +/- 3.1 g/24 h v C 3.1 +/- 2.7) were similar. Lesions by World Health Organization (WHO) class, activity, and chronicity indices, as well as immunofluorescence (IF) and electron microscopy (EM) findings, were not significantly different. Occlusive glomerular, arteriolar, and arterial fibrin thrombi, along with varying degrees of renal thrombotic microangiopathy, were seen in five of 33 patients with LA, but zero of 32 C patients (P = 0.053); three of these five patients died soon after biopsy. Overall, mortality was not different between LA and C. We conclude that the majority of patients with SLE, renal dysfunction, and LA exhibit renal morphologic findings indistinguishable from patients without LA. However, a significant minority of LA patients have thrombotic microangiopathy in their biopsy, which is accompanied by a worse prognosis.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Blood Coagulation - physiology</subject><subject>Capillaries - pathology</subject><subject>Female</subject><subject>Fibrin</subject><subject>Hemorrhage - physiopathology</subject><subject>Humans</subject><subject>Kidney - blood supply</subject><subject>Kidney Glomerulus - blood supply</subject><subject>Kidney Glomerulus - pathology</subject><subject>Lupus Coagulation Inhibitor - blood</subject><subject>Lupus Erythematosus, Systemic - blood</subject><subject>Lupus Erythematosus, Systemic - pathology</subject><subject>Lupus Nephritis - blood</subject><subject>Lupus Nephritis - pathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. 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E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c333t-78f4b559c279f6a9d28bca6334a50e2b67fc92661d9b23687bf1c23f454f40b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1992</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Blood Coagulation - physiology</topic><topic>Capillaries - pathology</topic><topic>Female</topic><topic>Fibrin</topic><topic>Hemorrhage - physiopathology</topic><topic>Humans</topic><topic>Kidney - blood supply</topic><topic>Kidney Glomerulus - blood supply</topic><topic>Kidney Glomerulus - pathology</topic><topic>Lupus Coagulation Inhibitor - blood</topic><topic>Lupus Erythematosus, Systemic - blood</topic><topic>Lupus Erythematosus, Systemic - pathology</topic><topic>Lupus Nephritis - blood</topic><topic>Lupus Nephritis - pathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Renovascular diseases</topic><topic>Thrombosis - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FARRUGIA, E</creatorcontrib><creatorcontrib>TORRES, V. E</creatorcontrib><creatorcontrib>GASTINEAU, D</creatorcontrib><creatorcontrib>MICHET, C. J</creatorcontrib><creatorcontrib>HOLLEY, K. E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FARRUGIA, E</au><au>TORRES, V. E</au><au>GASTINEAU, D</au><au>MICHET, C. J</au><au>HOLLEY, K. E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lupus anticoagulant in systemic lupus erythematosus : a clinical and renal pathological study</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>1992-11-01</date><risdate>1992</risdate><volume>20</volume><issue>5</issue><spage>463</spage><epage>471</epage><pages>463-471</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>Circulating lupus anticoagulant (LA) is associated with thrombosis in large and small vessels. To determine how often the presence of LA is associated with thrombosis within the renal microcirculation, 33 patients with systemic lupus erythematosus (SLE), renal dysfunction, and LA were identified over a 25-year period (LA group) and 32 patients with renal SLE but with normal gross coagulation screen were matched for age, sex, and biopsy timing (C group). Prevalences of serositis, neuropsychiatric illness, leukopenia, thrombocytopenia, hemolysis, anti-DS-DNA elevation, and complement reduction were similar. Arthritis was less and biologic false-positive (BFP) syphilis serology more common in LA. More LA patients had thrombotic events (LA 39% v C 13%; P = 0.014); bleeding episodes, including postbiopsy, were similar. At biopsy, hypertension (LA 55%, C 41%), serum creatinine (mean +/- SD: LA 186 +/- 168 mumol/L [2.1 +/- 1.9 mg/dL] v C 150 +/- 168 mumol/L [1.7 +/- 1.9 mg/dL]) and proteinuria (LA 2.6 +/- 3.1 g/24 h v C 3.1 +/- 2.7) were similar. Lesions by World Health Organization (WHO) class, activity, and chronicity indices, as well as immunofluorescence (IF) and electron microscopy (EM) findings, were not significantly different. Occlusive glomerular, arteriolar, and arterial fibrin thrombi, along with varying degrees of renal thrombotic microangiopathy, were seen in five of 33 patients with LA, but zero of 32 C patients (P = 0.053); three of these five patients died soon after biopsy. Overall, mortality was not different between LA and C. We conclude that the majority of patients with SLE, renal dysfunction, and LA exhibit renal morphologic findings indistinguishable from patients without LA. However, a significant minority of LA patients have thrombotic microangiopathy in their biopsy, which is accompanied by a worse prognosis.</abstract><cop>Orlando, FL</cop><pub>Elsevier</pub><pmid>1442758</pmid><doi>10.1016/S0272-6386(12)70258-5</doi><tpages>9</tpages></addata></record>
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subjects Adolescent
Adult
Biological and medical sciences
Blood Coagulation - physiology
Capillaries - pathology
Female
Fibrin
Hemorrhage - physiopathology
Humans
Kidney - blood supply
Kidney Glomerulus - blood supply
Kidney Glomerulus - pathology
Lupus Coagulation Inhibitor - blood
Lupus Erythematosus, Systemic - blood
Lupus Erythematosus, Systemic - pathology
Lupus Nephritis - blood
Lupus Nephritis - pathology
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Renovascular diseases
Thrombosis - pathology
title Lupus anticoagulant in systemic lupus erythematosus : a clinical and renal pathological study
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