Renal involvement in antiphospholipid syndrome

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombotic events and/or pregnancy morbidity in individuals with antiphospholipid antibodies (aPLs).
• APS can manifest as a primary condition or secondary to other autoimmune diseases like systemic lupus erythematosus (SLE).
• The kidney is a critical target organ in APS, with renal thrombosis occurring at various vascular levels.

Purpose of the Study:

• To elucidate the spectrum of renal manifestations in Antiphospholipid Syndrome (APS).
• To highlight the diagnostic and therapeutic implications of renal involvement in APS, particularly in patients with SLE.
• To underscore the growing importance of aPLs in various renal disease contexts.

Main Methods:

• Review of clinical and histological findings in APS patients with renal involvement.
• Analysis of diagnostic criteria and treatment strategies for renal APS.
• Evaluation of the impact of aPLs on renal prognosis in SLE and other conditions.

Main Results:

• Renal thrombosis in APS can affect arteries, glomerular capillaries, and veins, with diverse histological findings.
• Renal prognosis is significantly influenced by aPLs, especially in lupus nephritis, often requiring kidney biopsy for accurate diagnosis and treatment.
• Long-term warfarin anticoagulation is the standard treatment for definite APS with renal involvement.

Conclusions:

• Renal manifestations of APS are varied and increasingly recognized in end-stage renal disease, transplantation, and pregnancy.
• Prompt diagnosis and tailored treatment, considering both inflammatory and thrombotic components, are crucial for managing renal APS.
• Antiphospholipid antibodies (aPLs) play a pivotal role in the pathogenesis and clinical course of renal disease in APS and SLE.