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      Ischemic Stroke in a Young Patient with Nephrotic Syndrome and Antiphospholipid Syndrome

      case-report
      Author(s): 1 , , 1 , 1 , 2 , 1
      Publication date (Electronic):
      Journal: Case Reports in Nephrology
      Publisher: Hindawi

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          Abstract

          We report a case of a 21-year-old man with underlying nephrotic syndrome (NS) secondary to minimal change disease, who developed an ischemic stroke with left hemiparesis. He received intravenous thrombolysis followed by a mechanical thrombectomy. After mechanical thrombectomy, he developed acute kidney injury which subsequently required haemodialysis. Further workup revealed that he had concomitant antiphospholipid syndrome (APS) and NS. He was started on vitamin K antagonist anticoagulant. This case report illustrates the importance of workup in identifying causes of ischemic stroke in a young patient.

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          International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS).

          S Miyakis, M Lockshin, T Atsumi … (2006)
          New clinical, laboratory and experimental insights, since the 1999 publication of the Sapporo preliminary classification criteria for antiphospholipid syndrome (APS), had been addressed at a workshop in Sydney, Australia, before the Eleventh International Congress on antiphospholipid antibodies. In this document, we appraise the existing evidence on clinical and laboratory features of APS addressed during the forum. Based on this, we propose amendments to the Sapporo criteria. We also provide definitions on features of APS that were not included in the updated criteria.
          Article 0 comments Cited 707 times – based on 0 reviews     Review now
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            EULAR recommendations for the management of antiphospholipid syndrome in adults

            Maria G Tektonidou, Laura Andreoli, Marteen Limper … (2019)
            The objective was to develop evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. Based on evidence from a systematic literature review and expert opinion, overarching principles and recommendations were formulated and voted. High-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS. Risk modification includes screening for and management of cardiovascular and venous thrombosis risk factors, patient education about treatment adherence, and lifestyle counselling. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with systemic lupus erythematosus without prior thrombotic or obstetric APS, and non-pregnant women with a history of obstetric APS only, all with high-risk aPL profiles. Patients with APS and first unprovoked venous thrombosis should receive long-term treatment with vitamin K antagonists (VKA) with a target international normalised ratio (INR) of 2–3. In patients with APS with first arterial thrombosis, treatment with VKA with INR 2–3 or INR 3–4 is recommended, considering the individual’s bleeding/thrombosis risk. Rivaroxaban should not be used in patients with APS with triple aPL positivity. For patients with recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3–4 or switch to low molecular weight heparin may be considered. In women with prior obstetric APS, combination treatment with LDA and prophylactic dosage heparin during pregnancy is recommended. In patients with recurrent pregnancy complications, increase of heparin to therapeutic dose, addition of hydroxychloroquine or addition of low-dose prednisolone in the first trimester may be considered. These recommendations aim to guide treatment in adults with APS. High-quality evidence is limited, indicating a need for more research.
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              Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome

              Vittorio Pengo, Ariela Hoxha, Seena Padayattil Jose … (2018)
              Article 0 comments Cited 149 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                K. K. Neoh:
                ORCID: https://orcid.org/0000-0002-6633-448X
                Journal
                Journal ID (nlm-ta): Case Rep Nephrol
                Journal ID (iso-abbrev): Case Rep Nephrol
                Journal ID (publisher-id): CRIN
                Title: Case Reports in Nephrology
                Publisher: Hindawi
                ISSN (Print): 2090-6641
                ISSN (Electronic): 2090-665X
                Publication date Collection: 2020
                Publication date (Electronic): 25 November 2020
                Volume: 2020
                Electronic Location Identifier: 8828864
                Affiliations
                1Department of Internal Medicine, Seberang Jaya Hospital, Penang, Malaysia
                2Clinical Research Center (CRC), Seberang Jaya Hospital, Penang, Malaysia
                Author notes

                Academic Editor: Hern N. Trimarchi

                Author information
                https://orcid.org/0000-0002-6633-448X
                Article
                DOI: 10.1155/2020/8828864
                PMC ID: 7718048
                PubMed ID: 33294240
                SO-VID: 854c6f45-667f-43bc-8f26-fc02409bafcd
                Copyright © Copyright © 2020 K. K. Neoh et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 April 2020
                Date revision received : 29 October 2020
                Date accepted : 31 October 2020
                Categories
                Subject: Case Report

                Data availability:

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