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[Antiphospholipid syndrome and kidney].

D Roccatello1, D Rossi, O Giachino

  • 1Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare , Struttura Complessa a Direzione Universitaria di Immunologia Clinica, Ospedale San Giovanni Bosco, ASL 4, Torino. dario.roccatello@unito.it

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
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PubMed
Summary

Antiphospholipid syndrome (APS) frequently affects the kidneys, presenting diverse clinical patterns. Anticoagulation is the primary treatment for APS renal involvement, particularly in acute cases and renal artery stenosis.

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Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Context:

  • Antiphospholipid syndrome (APS) diagnosis relies on established clinical and laboratory criteria.
  • Renal involvement is a common manifestation of APS, encompassing various clinical presentations.
  • Distinguishing between large vessel and microvascular involvement is crucial for clinical management.

Purpose:

  • To outline the spectrum of renal manifestations in Antiphospholipid Syndrome (APS).
  • To discuss differential diagnoses for microvascular APS renal disease.
  • To highlight the prognostic implications and therapeutic strategies for kidney involvement in APS.

Summary:

  • Renal artery stenosis is frequent in APS, while microvascular involvement requires differentiation from other thrombotic microangiopathies.
  • Chronic APS renal disease often presents with hypertension, renal insufficiency, and proteinuria.
  • Kidney involvement is nearly universal in catastrophic APS, and prognosis is poorer in patients with coexisting systemic lupus erythematosus.

Impact:

  • This review clarifies the multifaceted renal impact of APS, aiding clinicians in diagnosis and management.
  • It emphasizes the importance of anticoagulation as the mainstay therapy for APS-related kidney disease.
  • Further research is needed to define the role of immunomodulatory therapies in managing APS nephropathy.