Comparative study of kidney affection in SLE patients with and without antiphospholipid syndrome

Aim of the workTo evaluate the incidence, clinical associations and outcome of APS nephropathy in SLE patients with 2ry APS.Patients and methodsWe studied 64 female SLE patients with nephritis; 32 of them had 2ry APS (group 1) and the rest without 2ry APS (group 2). Demographic, clinical and serological data were prospectively evaluated. Systemic lupus erythematosus disease activity index (SLEDAI) and Systemic Lupus International Collaboration Clinics/ACR damage index (SLICC) were assessed. Renal duplex, renal 99mTc-dimercaptosuccinic) scan (DMSA scan) and renal magnetic resonance angiography (MRA) were all used to detect renal vascular affection.ResultsThere were statistically significant differences between the two examined groups regarding damage index (p = 0.000), hypertension (p = 0.02), thrombocytopenia (p = 0.000), ↓LDL (p = 0.008), ↓C3 (p = 0.01) and TMA (p = 0.04). In group 1: MR angiography detected 7 patients with RAS: 5 patients with renal artery thrombosis that showed a significant association with TMA and proteinuria (p = 0.002, p = 0.004: p < 0.001, p = 0.02, respectively). Patients with RAS had ↑DBP, ↑s.creatinine and ↑TGs (p = 0.004, p = 0.005 and p = 0.0003, respectively). Renal DMSA detected 6 patients with cortical scar which showed a significant association with TMA, proteinuria, livedoreticularis and arthritis (p = 0.001, p = 0.01, p = 0.04 and p = 0.03, respectively) those patients had ↑DBP and ↑RI (p = 0.000 and p = 0.006, respectively).ConclusionaPL testing should become a routine investigation in patients evaluated for RAS or renal infarctions especially with hypertension and unexplainable deteriorating renal function. To confirm our results we propose that larger scale, multicentre studies with longer evaluation periods.