Renal artery stenosis in the antiphospholipid (Hughes) syndrome and hypertension

• Published in: Annals of the rheumatic diseases 2003-10, Vol.62 (10), p.999-1002
• Main Authors: Sangle, S R, D’Cruz, D P, Jan, W, Karim, M Y, Khamashta, M A, Abbs, I C, Hughes, G R V
• Format: Article
• Language: English
• Subjects: aCL; Adult; Age; Aged; angioplasty; anticardiolipin antibodies; anticoagulation; antiphospholipid antibodies; Antiphospholipid syndrome; Antiphospholipid Syndrome - complications; Antiphospholipid Syndrome - diagnostic imaging; Antiphospholipid Syndrome - pathology; aPL; APS; Arteries; Atherosclerosis; Biological and medical sciences; Blood pressure; BMI; body mass index; Cardiovascular disease; Care and treatment; Chi-Square Distribution; Complications and side effects; computed tomography; Concise Report; Coronary vessels; Diabetes; Diagnosis; Female; Hospitals; Humans; Hypertension; Hypertension - complications; Hypertension - diagnostic imaging; Hypertension - pathology; INR; international normalised ratio; Lupus; Magnetic Resonance Angiography; magnetic resonance imaging; magnetic resonance imaging angiography; Male; Medical imaging; Medical sciences; Middle Aged; Morbidity; MRA; ox-LDL; oxidised low density lipoprotein; Pregnancy; Radiography; RAS; Renal Artery - diagnostic imaging; Renal Artery - pathology; Renal Artery Obstruction - complications; Renal Artery Obstruction - diagnosis; renal artery stenosis; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; SLE; Stenosis; systemic lupus erythematosus; Thrombosis
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.62.10.999

Background: Hypertension is common in the antiphospholipid (Hughes) syndrome (APS) and its cause is poorly understood. Anecdotal evidence suggests that renal artery stenosis (RAS) may be a relevant and treatable cause of hypertension. Objective: To investigate the prevalence of RAS in patients with APS and hypertension. Patients and methods: Three groups of patients were evaluated: (1) 77 patients with positive antiphospholipid antibodies (aPL) (60 secondary APS, 11 primary APS, and 6 with aPL only) and uncontrolled hypertension who were receiving two or more antihypertensive drugs; (2) 91 patients (⩽50 years) attending hypertension clinics;(3) 92 normotensive healthy, potential renal transplant donors. Magnetic resonance renal angiography was used to image the renal arteries in all three groups. Results: Group 1: 20/77 (26%) patients had evidence of RAS (16 unilateral and 4 bilateral). Sixteen patients (80%) had smooth well defined stenoses in the proximal third of the renal artery. Three further patients had irregular arteries without distinct stenosis. Group 2: 7/91 (8%) hypertensive patients had RAS (χ2=10.3, p