Antiphospholipid Antibodies and Renal Outcomes in Patients with Lupus Nephritis

Yuki Tsuruta, Keiko Uchida, Mitsuyo Itabashi, Wako Yumura, Kosaku Nitta
2009 Internal medicine (Tokyo. 1992)  
Objective Previous studies have documented a high frequency of thrombotic events in lupus nephritis patients with antiphospholipid (aPL) antibodies in the serum, but there is little information on the impact of serum aPL antibodies on the clinical outcome of lupus nephritis. The aims of this study were to evaluate the seroprevalence of aPL antibodies in patients with lupus nephritis and assess their prognostic value in relation to long-term renal outcomes. Patients and Methods A retrospective
more » ... s A retrospective analysis was undertaken in 49 patients with lupus nephritis who underwent renal biopsy. The serum aPL antibodies were monitored regularly in the patients who were followed up for a mean of 76.4±47.2 months, and possible factors associated with the long-term renal outcomes in these patients were analyzed. Results The overall seroprevalence of aPL antibodies was 41%. During the follow-up, 40% of aPL antibody-positive patients experienced thrombotic events. The frequency of class V lupus nephritis was lower in the aPL antibody-positive patients (6 out of the 20 aPL antibody-positive vs. 14 out of the 29 patients aPL antibody-negative patients; p=0.03). A multivariate analysis identified age (p=0.0001), eGFR at presentation (p=0.0015) and presence of hypertension (p=0.0025) as independent risk factors for the development of chronic kidney disease (CKD) with eGFR less than 60 ml/min/1.73 m 2 . Conclusion Detection of aPL antibodies in the serum of patients with lupus nephritis is useful to identify patients at risk of thrombotic events. Hypertension is associated with the probability of CKD with eGFR less than 60 ml/min/1.73 m 2 . tions and reaction to drug use. These antibodies can be 4) . The kidney is one of the major organs affected in APS. A wide spectrum of renal manifestations has been described in association with the presence of aPL antibodies in the serum, including renal artery stenosis, renal infarction, renal vein thrombosis, acute or chronic thrombotic microangiopathy (5), and the more recently reported so-called APS nephropathy (6, 7) . Although there is evidence that the presence of aPL antibodies in the serum may place patients with SLE at an increased risk of vascular thrombotic events and pregnancy morbidity (5), data on the impact of seropositivity for aPL
doi:10.2169/internalmedicine.48.2363 pmid:19881237 fatcat:uh7afff7tjcp5jmfkrk65daymq