PMID- 31733722
OWN - NLM
STAT- MEDLINE
DCOM- 20200827
LR  - 20220329
IS  - 1548-5609 (Electronic)
IS  - 1548-5595 (Print)
IS  - 1548-5595 (Linking)
VI  - 26
IP  - 5
DP  - 2019 Sep
TI  - Antiphospholipid Syndrome Nephropathy and Other Thrombotic Microangiopathies 
      Among Patients With Systemic Lupus Erythematosus.
PG  - 376-386
LID - S1548-5595(19)30152-1 [pii]
LID - 10.1053/j.ackd.2019.08.012 [doi]
AB  - Antiphospholipid syndrome (APS) and other causes of thrombotic microangiopathy 
      (TMA) negatively impact the renal outcomes of patients with systemic lupus 
      erythematosus (SLE) and lupus nephritis. Here we review the diagnosis and 
      management of occlusive renal vascular lesions due to APS and other TMAs, with a 
      focus on patients with SLE and lupus nephritis. The presence of a thrombotic 
      event, unexplained hypertension, thrombocytopenia, or hemolytic anemia should 
      prompt consideration for TMA syndromes. The differential diagnosis of a TMA in a 
      patient with SLE includes APS, thrombocytopenic purpura, complement-mediated or 
      infection-associated hemolytic uremic syndrome, drug-mediated TMA (particularly 
      due to calcineurin inhibitor toxicity), and malignant hypertension. Treatment of 
      APS with a documented thrombotic event focuses on anticoagulation to reduce the 
      risk for further thrombotic events. Treatment of classic presentations of 
      thrombocytopenic purpura and hemolytic uremic syndrome in the SLE population is 
      the same as in patients without SLE. Treatment of APS nephropathy or TMA when it 
      is diagnosed by biopsy with concomitant lupus nephritis presents a challenge to 
      clinicians because there is no clear standard of care. Small and retrospective 
      studies suggest potential benefit of complement inhibition, mammalian target of 
      rapamycin (mTOR) inhibition, B cell depleting therapy, and plasma exchange 
      therapy for patients with lupus nephritis and TMA, and prospective investigation 
      of these therapies should be a research priority.
CI  - Copyright (c) 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All 
      rights reserved.
FAU - Kotzen, Elizabeth S
AU  - Kotzen ES
AD  - Division of Nephrology and Hypertension, Department of Medicine, University of 
      North Carolina at Chapel Hill, Chapel Hill, NC.
FAU - Roy, Sanjeet
AU  - Roy S
AD  - Division of Nephropathology, Department of Pathology and Laboratory Medicine, 
      University of North Carolina at Chapel Hill, Chapel Hill, NC.
FAU - Jain, Koyal
AU  - Jain K
AD  - Division of Nephrology and Hypertension, Department of Medicine, University of 
      North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: 
      koyal_jain@med.unc.edu.
LA  - eng
GR  - T32 DK007750/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Adv Chronic Kidney Dis
JT  - Advances in chronic kidney disease
JID - 101209214
SB  - IM
MH  - Antiphospholipid Syndrome/*complications
MH  - Diagnosis, Differential
MH  - Humans
MH  - *Kidney/blood supply/pathology
MH  - Lupus Erythematosus, Systemic/*complications
MH  - Lupus Nephritis/*diagnosis
MH  - Nephritis/classification/*diagnosis/etiology
MH  - Thrombotic Microangiopathies/*complications
PMC - PMC8958719
MID - NIHMS1577961
OTO - NOTNLM
OT  - Antiphospholipid syndrome
OT  - Lupus nephritis
OT  - Systemic lupus erythematosus
OT  - Thrombotic microangiopathy
EDAT- 2019/11/18 06:00
MHDA- 2020/08/28 06:00
PMCR- 2022/03/28
CRDT- 2019/11/18 06:00
PHST- 2019/02/01 00:00 [received]
PHST- 2019/06/07 00:00 [revised]
PHST- 2019/08/19 00:00 [accepted]
PHST- 2019/11/18 06:00 [entrez]
PHST- 2019/11/18 06:00 [pubmed]
PHST- 2020/08/28 06:00 [medline]
PHST- 2022/03/28 00:00 [pmc-release]
AID - S1548-5595(19)30152-1 [pii]
AID - 10.1053/j.ackd.2019.08.012 [doi]
PST - ppublish
SO  - Adv Chronic Kidney Dis. 2019 Sep;26(5):376-386. doi: 10.1053/j.ackd.2019.08.012.