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 |
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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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E ; GASTINEAU, D ; MICHET, C. J ; HOLLEY, K. E</creator><creatorcontrib>FARRUGIA, E ; TORRES, V. E ; GASTINEAU, D ; MICHET, C. J ; HOLLEY, K. E</creatorcontrib><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><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1016/S0272-6386(12)70258-5</identifier><identifier>PMID: 1442758</identifier><language>eng</language><publisher>Orlando, FL: Elsevier</publisher><subject>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</subject><ispartof>American journal of kidney diseases, 1992-11, Vol.20 (5), p.463-471</ispartof><rights>1993 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c333t-78f4b559c279f6a9d28bca6334a50e2b67fc92661d9b23687bf1c23f454f40b03</citedby><cites>FETCH-LOGICAL-c333t-78f4b559c279f6a9d28bca6334a50e2b67fc92661d9b23687bf1c23f454f40b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4405458$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1442758$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FARRUGIA, E</creatorcontrib><creatorcontrib>TORRES, V. 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. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Renovascular diseases</subject><subject>Thrombosis - pathology</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1992</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkMtOwzAQRS0EKqXwCZWyQAgWAb_jsEMVL6kSC2CJLMexW6O8sJNF_h43rWA1M773jjUHgCWCtwgifvcOcYZTTgS_Rvgmg5iJlB2BOWKYpFwQcQzmf5ZTcBbCN4QwJ5zPwAxRijMm5uBrPXRDSFTTO92qzVDFLnFNEsbQm9rppJp048d-a2rVtyFO94lKdOUap1UVo2XiTRO7TvXbtmo303Poh3I8BydWVcFcHOoCfD49fqxe0vXb8-vqYZ1qQkifZsLSgrFc4yy3XOUlFoVWnBCqGDS44JnVOeYclXmBCRdZYZHGxFJGLYUFJAtwtd_b-fZnMKGXtQvaVPEa0w5BZoQwEjFEI9sbtW9D8MbKzrta-VEiKHdY5YRV7phJhOWEVbKYWx4-GIralP-pPceoXx50FeL11qtGu_BnoxQyGm2_eF-AtA</recordid><startdate>19921101</startdate><enddate>19921101</enddate><creator>FARRUGIA, E</creator><creator>TORRES, V. E</creator><creator>GASTINEAU, D</creator><creator>MICHET, C. J</creator><creator>HOLLEY, K. E</creator><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19921101</creationdate><title>Lupus anticoagulant in systemic lupus erythematosus : a clinical and renal pathological study</title><author>FARRUGIA, E ; TORRES, V. E ; GASTINEAU, D ; MICHET, C. J ; HOLLEY, K. 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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