ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 169

Prognosis of Patients with Antiphospholipid Syndrome Nephropathy

Clémentine Rousselin1, Zahir Amoura2, Alexandre Karras3, Dominique Guerrot4, Jean-Jacques Boffa5, Guillaume Canaud6, Stanislas Faguer7, Eric Auxenfants8, Noémie Jourde-Chiche9, Marc Lambert10 and Thomas Quémeneur11, 1Department of internal medicine, Hopital de Valenciennes, France, Valenciennes, France, 2Université Pierre et Marie Curie, Paris, France, 3Department of Nephrology, Hôpital Européen Georges Pompidou, APHP, Paris, France, Paris, France, 4Service de Néphrologie, Department of Nephrology, Centre Hospitalier de Rouen, France, Rouen, France, 5Department of Nephrology, Hôpital Tenon, France, Paris, France, 6Department of Nephrology and Transplantation, Necker-Enfants Malade, Université Paris Descartes, Sorbonne Paris Cité, INSERM U1151, Necker-Enfants Malades Hospital, Paris, France AP-HP, Paris, France, PARIS, France, 7Nephrology, CHU, Toulouse, France, 8CH Roubaix - Médecine interne, Roubaix, France, 9Nephrology, Department of Nephrology, AP-HM, CHU Conception, Marseille, France, Marseille, France, 10Lille, Lille, France, 11Department of Internal Medicine, CH of Valenciennes, France, Valenciennes, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Sunday, October 21, 2018

Title: Antiphospholipid Syndrome Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Antiphospholipid syndrome (APS) is associated with several patterns of renal involvement. Among them, antiphospholipid nephropathy (APSN) is a rare but specific pattern resulting from microvascular lesions. APSN prognosis, outside lupus nephritis, is unknown. We aimed to describe the renal, vascular and general prognosis of patients with APSN.

Methods: We performed a retrospective multicenter study on patients with antiphospholipid antibodies associated with APSN lesions, and no other nephropathy. Patients were identified through a national call for medical reports. End-stage renal disease (ESRD)-free survival, thrombosis recurrence-free survival and overall survival were assessed. Factors associated with estimated glomerular filtration rate (eGFR) change were also analysed.

Results: Twenty-five patients were included : 18 (72%) women, median age 38.8 (24.6-68.7) years. Seventeen (68%) had APS according to revised Sapporo criteria, 22 (88%) with lupus anticoagulant, 14 (56%) with triple positivity. Median blood pressure was 132 (110-214) / 79.5 (60-124) mmHg, median eGFR was 47.8 (5.8-103) mL/min/1.73m², median proteinuria was 0.95 (0.14-5) g/day. On renal biopsy 13 (52%) had glomerular thrombotic microangiopathy, 17 (68%) fibrous intimal hyperplasia and 3 (12%) focal cortical atrophy. Moderate to severe interstitial fibrosis (≥ 25%) was observed in 11 (44%) patients. Three patients developed ESRD after a median follow-up of 4.4 (0.4-38.3) years,. ESRD-free survival at 5 years was 82.3% (IC95% 65.5%-100%). Two other patients presented a 30% decrease in eGFR. No factor was significantly associated with annual change in eGFR. However patients with interstitial fibrosis (≥ 25%) seemed to have steeper eGFR decline (-0.08 (-4.42;7.005) ; 3.03 (-18.23;14.05) ; p=0.06). Thrombosis recurrence-free survival was 96% at 5 years (IC95% 88.7%-100%), 74% at 10 years (IC95% 51%-100%). One patient died during follow-up. Overall survival was 100% at 5 years and 90% at 10 years (IC95% 73%-100%).

Conclusion: The renal prognosis of isolated APSN is poor in this young population. Up to 20% of patients developed ESRD at 5 years. Severe lesions of renal fibrosis suggest a late diagnosis. The early detection of renal features could improve prognosis with the possibility of evaluating the efficacy of anti-proliferative treatments in APSN.

Disclosure: C. Rousselin, None; Z. Amoura, None; A. Karras, None; D. Guerrot, None; J. J. Boffa, None; G. Canaud, None; S. Faguer, None; E. Auxenfants, None; N. Jourde-Chiche, None; M. Lambert, None; T. Quémeneur, None.

To cite this abstract in AMA style:

Rousselin C, Amoura Z, Karras A, Guerrot D, Boffa JJ, Canaud G, Faguer S, Auxenfants E, Jourde-Chiche N, Lambert M, Quémeneur T. Prognosis of Patients with Antiphospholipid Syndrome Nephropathy [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/prognosis-of-patients-with-antiphospholipid-syndrome-nephropathy/. Accessed .

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