Postpartum bilateral renal vein thrombosis in the primary antiphospholipid syndrome

A young Caucasian woman developed bilateral deep vein thromboses (DVT) while taking the oral contraceptive (OC) in 1984. After a 9-month period of longterm anticoagulation therapy with warfarin, she experienced recurrent DVT 2 weeks following discontinuation of anticoagulation. She was then maintained with warfarin for the following 6 years. Elevated antibodies to cardiolipin (IgG aCL) were first detected in 1988. In 1990, warfarin was switched to aspirin and low molecular weight heparin as she wished to become pregnant. At 24 weeks she developed eclampsia and labor was induced. During the first postpartum week she experienced loin pain, associated with rapidly rising creatinine levels and features of a nephrotic syndrome. An abdominal ultrasound showed bilateral renal vein thrombosis with enlarged kidneys. She was treated with continuous ambulatory peritoneal dialysis (CAPD) for 4 months and her renal function is now recovering. Our patient is another example of the primary antiphospholipid syndrome.