Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Our previous data showed renal artery stenosis (RAS) is more prevalent in antiphospholipid syndrome(APS)(26%) compared to the general hypertensive population(8%),and anticoagulation with INR>=3 was associated with initial reduction of chronic kidney disease(CKD) and hypertension.
Methods: We identified 37 patients with RAS and APS fulfilling Sapporo criteria: anticardiolipin IgG/IgM titer>40 units or >99thpercentile (or +lupus anticoagulant) on >=2 occasions >=6 weeks apart AND vascular thrombosis(or pregnancy morbidity). RAS was diagnosed by magnetic resonance angiography(MRA).
Results: 15 patients had APS alone and 22 APS associated with autoimmune conditions (13 lupus, 5 ANCA vasculitis, 4 mixed). Median age at RAS diagnosis was 48 years, 31/37(83.8%) were female and median follow-up was 10.4 years. 25/37(67.6%) had previous thrombosis. 7/37(18.9%) had bilateral RAS, 3 artery occlusion. 6/37(16.2%) had concurrent coeliac stenosis. Recanalization of RAS occurred after hydroxychloroquine in 3/37 and 9/37(24.3%) underwent angioplasty+/-stenting. MRA was repeated in 11/37(29.7%) after 2 years. 23/37(62.2%) were anticoagulated, with 9/37(24.3%) on antiplatelet therapy. 13/37(35.1%) received hydroxychloroquine, 10/22(45.5%) immunosuppressives and 18/37(48.6%) antihypertensives. 9/37(24.3%) died after a median of 10 years since RAS diagnosis. 21/37(56.8%) developed CKD: 6 endstage renal failure(ESRD) and 15 with median eGFR 39 mls/min.
|
Patient Group |
CKD |
ESRD |
Death |
|
Anticoagulation(23) |
15/23 |
4/23 |
5/23 |
|
No anticoagulation(14) |
6/14 |
2/14 |
4/14 |
|
p value |
0.3 |
1.0 |
0.7 |
|
|
|
|
|
|
APS(15) |
7/15 |
3/15 |
1/15 |
|
APS+autoimmune disease(22) |
14/22 |
3/22 |
5/22 |
|
p |
0.3 |
0.7 |
0.4 |
|
|
|
|
|
|
Medical therapy(28) |
13/28 |
3/28 |
7/28 |
|
Angioplasty (9) |
8/9 |
3/9 |
2/9 |
|
p |
0.05 |
0.14 |
1 |
Conclusion: The majority of patients with RAS and APS were female, developed CKD and did not benefit from angioplasty. Anticoagulation was not associated with longterm reduction of ESRD or death, suggesting a non-thrombotic pathogenic process underlying RAS, e.g.intimal hyperplasia. Treatment of associated vascular risk factors and underlying autoimmune disease is paramount. Anticardiolipin antibodies and renal MRA are useful for screening hypertensive lupus patients.
To cite this abstract in AMA style:
Casian A, Sangle (joint 1st author) S, Manoustathopoulou S, D'Cruz DP. Anticoagulation and Longterm Outcomes in Patients with Renal Artery Stenosis and Antiphospholipid Syndrome [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/anticoagulation-and-longterm-outcomes-in-patients-with-renal-artery-stenosis-and-antiphospholipid-syndrome/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/anticoagulation-and-longterm-outcomes-in-patients-with-renal-artery-stenosis-and-antiphospholipid-syndrome/