• Internal medicine · Sep 2023

    Case Reports

    A Case of Antiphospholipid Syndrome Nephropathy with Acute Thrombotic Microangiopathy After Renal Transplantation.

    • Atsuhiko Suenaga, Naoki Sawa, Katsuyuki Miki, Takayoshi Yokoyama, Yasuo Ishii, Hiroki Mizuno, Daisuke Ikuma, Yuki Oba, Akinari Sekine, Masayuki Yamanouchi, Eiko Hasegawa, Tatsuya Suwabe, Kei Kono, Keiichi Kinowaki, Kenichi Ohashi, Kazuho Honda, Motoaki Miyazono, Yuki Nakamura, and Yoshifumi Ubara.
    • Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan.
    • Intern. Med. 2023 Sep 15; 62 (18): 270727132707-2713.

    AbstractWe experienced a 36-year-old man with lupus nephritis and antiphospholipid syndrome (APS) who received a donor kidney from his father. Twenty-two months after transplantation, at a time of poor adherence to immunosuppressants and warfarin, the patient developed sudden graft loss due to hemolytic uremic syndrome with rapid deterioration of renal function, thrombocytopenia, and hemolytic anemia. A kidney biopsy showed thrombotic microangiopathy (TMA) related to platelet thrombus formation; however, there was no recurrence of lupus and no findings suggestive of post-transplant rejection, so acute TMA associated with APS was thought to be the cause of the graft loss. This case highlights the importance of instructing patients with lupus nephritis to adhere to treatment with warfarin, a therapeutic drug for APS.

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