Background In patients with lupus nephritis, the presence of antiphospholipid antibodies (aPL) is considered to be an indication of increased risk of thrombotic microangiopathy, a serious complication of SLE 1.
Objectives To assess the occurrence of vascular access thrombosis in SLE patients on regular hemodialysis & its relation to the presence of antiphospholipid antibodies.
Methods The study included 50 SLE female patients on regular hemodialysis; patients further subdivided into; group A included 34 patients with thrombotic history and/or fetal loss and group B included 16 patients without thrombosis and group C 20 female patients on regular hemodialysis with end stage renal disease caused by diseases other than SLE with age matching as a control group. All recruited from the dialysis units in Ahmed Maher Teaching Hospital, and Ain Shams University Hospital. After informed consent all the study population underwent full history taking, detailed clinical examination, measurement of anti-ds DNA, ANA, anticardiolipin IgG & IgM and lupus anticoagulant in addition to CBC, PT, PTT, Creatinine, ALT & AST and duplex on A-V fistula with measurement of intima media thickness.
Results Age & dialysis duration matched groups were selected (37.24±8.88, 35.69±10.91 vs 37.15±9.21 yrs & 5±3.06, 5.06±3.04 vs 5.65±3.17 yrs respectively). We found that the level of anticardiolipin IgG & IgM and lupus anticoagulant were highly significantly higher in patients of group A than group B than group C (62.18±8.84 vs 20.74±5.73vs 13.41±5.70 u/ml, 46.96±9.72 vs 9.99±3.85 vs 7.12±2.68 u/ml, 63.26±12.05 vs 38.31±6.33 vs 2±0 respectively) (p<0.001). Also there was a highly significant thrombocytopenia in group A (132.41±15.10 vs 270.56±64.78 vs 264.05±67.80x103/μl) with prolonged PT and PTT (17.14±1.74 vs 13.47±1.55 vs 12.40±2.33 sec. and 45.24±6.32 vs 33.25±4.71 vs 29.55±3.62 sec) than group B & group C (p<0.001). There was a highly significant increase in intima media thickness of A-V fistula in group A than group B & group C (119.94±22.22 vs 51.19±15.58 vs 61.91±34.55 mm) (p<0.001).
Conclusions SLE patients on regular hemodialysis with positive antiphospholipid antibodies have higher incidence of occurrence of vascular access thrombosis.
Cohen D, Koopmans M, Kremer Hovinga IC, et al. Potential for glomerular C4d as an indicator of thrombotic microangiopathy in lupus nephritis. Arthritis Rheum. 2008; 58: 2460–9.
Acknowledgement We thanks all patients participating with us in this study.
Disclosure of Interest None declared