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      Anticardiolipin Antibodies in South African Patients with Lupus Nephritis: A Clinical and Renal Pathological Study

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          Abstract

          Aims: This study was conducted prospectively to ascertain the prevalence of anticardiolipin antibodies (ACAs) in patients with lupus nephritis and to determine whether this subgroup of patients differed clinically and histologically from patients without the antibody. Patients and Methods: 40 SLE patients (26 Blacks, 14 Indians, 37 females, 3 males) with evidence of renal involvement underwent clinical assessment and percutaneous renal biopsy. Special investigations included: urinary protein quantitation; radioisotope glomerular filtration rate (GFR); complement levels, and antinuclear antibodies and ACAs. Histology was reviewed by a single senior pathologist blinded to the ACA results. In addition to the standard WHO classification, specimens were examined for intrarenal thrombosis. Results: The prevalence of ACA was 45% (18 of 40 patients). Thrombocytopenia was more frequent in patients with ACA (33 vs. 13.6%, p = 0.015). Patients with ACA did not differ from controls with regard to the incidence of thrombosis, neurological disorders, recurrent fetal loss, active disease and hypertension. Mean GFR and 24-hour urine protein (ACA vs. controls) were 51.3 versus 67 ml/min (NS) and 2.4 versus 3.7 g (NS), respectively. Intrarenal microvascular thrombosis (glomerular and arteriolar) occurred in 27.7% of ACA patients versus 9% of controls (p = 0.025). Apart from a higher incidence of class-III nephritis in the controls, standard histology (WHO classification) did not differ between the 2 groups. Conclusion: The prevalence of ACA in our patients with lupus nephritis was 45%. This subgroup did not differ from patients without the antibody apart from a higher incidence of thrombocytopenia and intrarenal microvascular thrombosis.

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          Thrombosis, recurrent fetal loss, and thrombocytopenia. Predictive value of the anticardiolipin antibody test.

          To determine the predictive value of the IgG anticardiolipin antibody (ACA) test for thrombosis, recurrent fetal loss, and thrombocytopenia, the clinical features of 121 patients with varying antibody levels were studied. When patients were grouped into high-positive, low-positive, and normal groups according to their ACA levels, there were strong statistical correlations with arterial thrombosis, venous thrombosis, fetal loss, thrombocytopenia, and a positive Coombs' test. At levels of 7 SD and above, the test was highly specific (greater than 80%) and predictive (greater than 70%) for thrombosis, thrombocytopenia, and recurrent fetal loss. This study suggests that the IgG ACA test may be a useful predictor for thrombosis, recurrent fetal loss, and thrombocytopenia in patients with autoimmune disorders.
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            Author and article information

            Journal
            AJN
            Am J Nephrol
            10.1159/issn.0250-8095
            American Journal of Nephrology
            S. Karger AG
            0250-8095
            1421-9670
            2000
            October 2000
            15 November 2000
            : 20
            : 5
            : 351-357
            Affiliations
            Renal Unit, King Edward VIII Hospital, Departments of Medicine and Anatomical Pathology, University of Natal, Durban, South Africa
            Article
            13615 Am J Nephrol 2000;20:351–357
            10.1159/000013615
            11092990
            © 2000 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 1, Tables: 4, References: 38, Pages: 7
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/13615
            Categories
            Clinical Study

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