首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 15 毫秒
1.
2.
Antiphospholipid antibody syndrome   总被引:2,自引:0,他引:2  
Opinion statement When the diagnosis of antiphospholipid antibody syndrome (aPS) is being considered in persons who have experienced an ischemic stroke or a transient ischemic attack, it is important to gauge how well the history and laboratory data fit with this diagnosis as opposed to other causes of infarct. The fewer the number of typical vascular disease risk factors and the more confirmatory the laboratory findings (ie, high anticardiolipin antibody titers or presence of lupus anticoagulant), the stronger the suspicion of aPS. There are no good prospective randomized data on stroke prevention with any form of therapy following a first stroke or transient ischemic attack associated with antiphospholipid antibody (aPL). Short-term anticoagulation with an International Normalized Ratio (INR) of 2.0 to 3.0 may be considered in these cases, as could antiplatelet agents if no clear cardiac source is found. If anticoagulation is chosen, if there is no recurrence, and if the level of aPL appears to decline, a change to a stroke prevention medication that may carry less risk, such as an antiplatelet agent, may be appropriate. In patients with more typical vascular disease risk factors and less confirmatory laboratory evidence of aPS (ie, low to moderate titer of anticardiolipin antibodies and lack of other clinical or serologic evidence of aPS), a more conservative approach may be considered and antiplatelet therapy initiated. In either situation, close follow-up for recurrent thrombosis and aPL can help determine whether more or less aggressive (risky) therapies should be considered. Results of randomized controlled trials of different treatment options for aPS are awaited.  相似文献   

3.
Antiphospholipid syndrome (APS) may occur in isolation or in association with systemic lupus erythematosus (SLE), with the potential to cause renal failure via several distinct pathologies. Renal transplantation in the presence of APS carries a risk of early graft loss from arterial or venous thrombosis, or thrombotic microangiopathy (TMA). Whilst perioperative anticoagulation reduces the risk of large vessel thrombosis, it may result in significant haemorrhage, and its efficacy in preventing post‐transplant TMA is uncertain. Here, we report a patient with end‐stage kidney disease (ESKD) due to lupus nephritis and APS, in whom allograft TMA developed soon after transplantation despite partial anticoagulation. TMA resolved with plasma exchange‐based therapy albeit with some irreversible graft damage and renal impairment. We discuss the differential diagnosis of post‐transplant TMA, and current treatment options.  相似文献   

4.
Abstract: Background: The aim was to assess the presence of pre‐ or post‐transplant serum antiphospholipid antibodies (APA) and its association with the development of cardiovascular disease (CVD) in renal transplantation. Methods: We studied 138 patients transplanted with a cadaver kidney graft between 1990 and 1998 and with a graft functioning for longer than one yr. One pre‐transplant sample and another obtained after transplantation from our serum bank were analyzed. The ELISA used were set up in our laboratory, following established international guidelines, and results were confirmed in three different runs. Results: 23.9% and 31.2% of patients had pre‐ and post‐transplant positive titers of APA, respectively. 16% developed those antibodies de novo after transplantation. Post‐transplant CVD was observed in 20.3% of patients but they were not associated with the production of APA in the whole population studied. However, multivariate analysis demonstrated an increased risk (RR 2.27; p = 0.02) for CVD when APA were produced after acute rejection. Conclusions: The presence of serum APA alone was not an independent risk factor for CVD after kidney transplantation. Nonetheless, in kidney recipients who produced APA de novo after acute rejection, the control of cardiovascular risk factors must be intensified.  相似文献   

5.
6.
7.
STUDY DESIGN: Case report. OBJECTIVES: To report a rare cause of spinal subdural hematoma. SETTING: A tertiary care university hospital in Andhra Pradesh, India. METHODS: Detailed evaluation and reporting of a case admitted in the hospital. RESULTS: A case of antiphospholipid antibody syndrome (APS) was found to present with spontaneous spinal subdural hematoma and paraplegia. This is a very rare presentation of APS. CONCLUSION: This article describes a rare case of APS presenting with disseminated bleeding and spontaneous spinal subdural hematoma, resulting in paraplegia.  相似文献   

8.
The case of a 11-year-old boy under anticoagulant therapy for a familial antiphospholipid antibody syndrome (SAAPF), who underwent surgery for a cerebrovascular malformation responsible for an intracerebral haematoma, is reported. Antivitamins K (AVK) were changed for unfractioned heparin (HNF), three days before. Heparin was discontinued two hours prior to surgery to obtain a normal peroperative coagulation. A vascular dural fistula was removed without any haemostatic problem. The neurological status rapidly returned to normal and tomodensitometry at day 1 showed a normal intracranial status. Heparin was readministered at h 16. Thrombocytopenia occurred at day 4 of heparin treatment. The change for a low weight molecular heparinoid, danaparoid (Orgaran), normalized the platelet count. The platelets aggregation tests were negative during thrombopenia. However, the test for antibodies against the PF4-heparin complex with the Elisa technique, was in favour of a heparin induced thrombocytopenia (TIH). In spite of its anecdotic occurrence due to cumulative thrombotic risks from the association of immunologic disorders (TIH and SAAPF), this case report underlines the value but also the risks of anticoagulant therapy in neurosurgery, when patients are at high risk for thrombosis.  相似文献   

9.
AIMS: End-stage renal disease (ESRD) patients with antiphospholipid antibody syndrome (APAS) remain at high risk for the development of posttransplant renal thrombosis without the benefit of anticoagulation therapy. This study describes the clinical management of these high-risk patients on anticoagulation therapy. METHODS: In this study period, 802 patients awaiting renal transplantation were screened for APAS. Twenty-seven of these patients (3%) had APAS. Of these 27, nine patients received cadaveric kidney transplants along with 409 patients who did not have APAS. Of the nine patients, seven were treated with coumadin and the remaining two were treated with heparin. RESULTS: Of the seven patients treated with coumadin, five did not have thrombotic complications posttransplant. However, three of these patients were taken off coumadin due to bleeding complications at 6 months to 1 year posttransplant. They all returned to dialysis shortly thereafter. The remaining two patients have maintained their allografts on coumadin therapy for 3 and 5 years posttransplants. The other two patients had posttransplant renal thrombosis within 24 hours of their transplant despite coumadin therapy. Of the two patients treated with heparin, one is doing well at 6 years posttransplant while the other had early allograft loss due to thrombosis. CONCLUSIONS: ESRD patients with APAS may benefit from anticoagulation therapy; however, early allograft loss and bleeding complication are two serious side effects of this therapy.  相似文献   

10.
Antiphospholipid (aPL) antibodies in end-stage renal disease.   总被引:2,自引:0,他引:2  
Data are few and conflicting about the prevalence and risk factors for antiphospholipid (aPL) antibodies in end-stage renal disease (ESRD). We studied the prevalence, risk factors and clinical manifestations of lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) among ESRD patients (chronic hemodialysis (HD) patients and kidney transplant recipients) and blood donors. LA was assessed in a large cohort (n=180) of patients by the activated partial thromboplastin time (aPTT), dilute Russel's viper venom test (dRVVT) and lupus anticoagulant-sensitive aPTT reagent (PTT-LA). IgM- and IgG-aCL were measured by a solid-phase enzyme-linked immunosorbent assay (ELISA) in 111 patients (61.5%). The prevalence of aPL was low but, it was higher in ESRD than blood donors (8.8% (16/180) vs. 0%, P=0.005); the frequency of aCL was also higher in ESRD than controls (10.8% (12/111) vs. 0%, P=0.002). LA was similar in the study and control groups (2.2% (4/180) vs. 0%, NS). Among HD patients and kidney allograft recipients there was no difference in LA (3.9% (4/101) vs. 0% (0/79), NS) and aCL frequency (18.6% (8/43) vs. 5.9% (4/68), NS). aPL was not associated with sex, age, time on HD, post-transplantation follow-up, ESRD etiology, thrombotic or hemorrhagic events, or type of HD membrane; however, these findings must be interpreted with caution, given the low frequency of aPL. In one HD patient LA activity was associated with multiple thrombosis of the access graft and native veins. In summary, the prevalence of aPL in ESRD is low but nevertheless higher than controls; LA does not appear to be related to membrane bio-incompatibility and it may be linked to vascular thrombosis; the lack of concordance between LA and aCL was apparent. Further studies are needed to clarify the issue of aPL in ESRD. LA testing should be incorporated into the diagnostic evaluation of recurrent thrombotic episodes in patients on HD.  相似文献   

11.
Antiphospholipid syndrome nephropathy   总被引:2,自引:0,他引:2  
  相似文献   

12.
Antiphospholipid syndrome is an uncommon auto-immune disease presenting with various clinical manifestations that may lead to surgical intervention and sometimes even life-threatening emergencies. This syndrome presents with venous and arterial thrombosis of many organs such as liver, kidney and of the skin etc. Clinical manifestations may mimic hematological disorders and be misdiagnosed in some cases due to the complexity of the symptoms. In the present study, a 65-year-old man with APS syndrome presenting with severe abdominal organ pathologies that required surgical intervention, is reported.  相似文献   

13.
BACKGROUND: End-stage renal disease (ESRD) patients with antiphospholipid antibody syndrome (APAS) remain at high risk for the development of renal thrombosis without the benefit of anticoagulation therapy. This study examines the efficacy of anticoagulation therapy in this high-risk patient population. METHOD: Of nine APAS renal-transplant patients, seven were treated with coumadin, whereas two were treated with heparin. RESULTS: Of the two patients treated with heparin, one had early allograft loss, whereas the other patient is doing fine at 5 years posttransplant. Of the seven 7 patients treated with coumadin, two patients are doing well at 2 and 3 years posttransplant, two had early allograft loss, the remaining three patients returned to dialysis after they were taken off of the coumadin at 6, 12, and 20 months posttransplant because of bleeding complications. CONCLUSIONS: Anticoagulation therapy is beneficial to some but not all APAS patients. In addition, bleeding complications are a serious side effect of this therapy.  相似文献   

14.
15.
(Received for publication on Sept. 17, 1996; accepted on May 12, 1997)  相似文献   

16.
Renal biopsies occasionally show a combination of thrombotic microangiopathy as a result of antiphospholipid syndrome and lupus nephritis. The thrombosis in this case preceded the onset of lupus probably by approximately 8 yr, consisting of repeated fetal loss and venous thrombosis. More severe disease may have both arterial and venous thrombotic manifestations, including pulmonary emboli and cerebrovascular lesions. The antiphospholipid syndrome bears no relationship to the class of lupus nephritis but is accompanied by more frequent and greater hypertension and greater azotemia and interstitial fibrosis, and is associated with worse outcomes than lupus nephritis without antiphospholipid syndrome.  相似文献   

17.
18.
19.
20.
Anti-cardiolipin antibodies have been linked to recurrent arterial and venous thrombosis in multiple organs. We present a biopsy-documented report of thrombotic renal disease apparently attributable to circulating anti-cardiolipin antibodies. One patient had primary anti-cardiolipin syndrome, one had mild SLE, and the third had a mild lupus-like syndrome. All three patients had a clinical course dominated by repeated multi-organ system thrombosis. Renal biopsy disclosed thrombosis at the level of the glomerular capillaries, arterioles, and interlobular arteries--similar to that described in other thrombotic microangiopathies. Renal thrombosis was not associated with active endocapillary proliferative lupus nephritis, suggesting a mechanism independent of subendothelial immune deposit injury. Renal presentation was variable, ranging from asymptomatic mild proteinuria to nephrotic-range proteinuria, renal insufficiency, and hypertension.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号