Antiphospholipid antibodies (aPL) are considered to be non-pathogenic in patients with vasculitis. We present five patients with primary vasculitis who had aPL and renal artery stenosis (RAS); one of these patients had coexistent renal pathology due to primary vasculitis, and micro- and macropathology due to renal manifestations of the antiphospholipid syndrome.

A 44 year old white smoker presented with sinusitis, haemoptysis, and arthritis. She was normotensive. A chest x ray demonstrated cavitating lesions. She was cANCA positive and fulfilled the American College of Rheumatology criteria for Wegener’s granulomatosis (WG).¹ aPL were detected, although she lacked a history of thromboses or pregnancy morbidity. Her serum C reactive protein level was raised at 100 mg/l. Clinical and serological remission was achieved with intravenous cyclophosphamide followed by maintenance methotrexate and corticosteroid treatment.

After discontinuing corticosteroids, she became hypertensive and her previously normal renal function deteriorated. Her …