An atypical hydronephrosis revealing urinary tract involvement in antiphospholipid syndrome

  • Claire de Moreuil Service de Médecine interne, CHRU de Brest, Hôpital La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex,
  • Anne-Marie Piette Service de Médecine interne, Hôpital Foch, 40 rue Worth, 92151, Suresnes
  • Jean-Marie Hervé Service d’Urologie, Hôpital Foch, 40 rue Worth, 92151, Suresnes
  • Philippe Camparo Service d’Anatomo-Pathologie, Hôpital Foch, 40 rue Worth, 92151, Suresnes
  • Anne-Catherine Baglin Service d’Anatomo-Pathologie, Hôpital Foch, 40 rue Worth, 92151, Suresnes
  • Olivier Blétry Service de Médecine interne, Hôpital Foch, 40 rue Worth, 92151, Suresnes
  • Jean-Emmanuel Kahn Service de Médecine interne, Hôpital Foch, 40 rue Worth, 92151, Suresnes
Keywords: Antiphospholipid syndrome, Thrombosis, Hydronephrosis, Acute renal failure

Abstract

Urinary tract involvement is rarely described in APS. We report the case of a 40 year-old man with primitive APS who was diagnosed an arterial and venous unilateral ureteral ischemia, revealed by a hydronephrosis. He had been on oral anticoagulation for six years because of two deep venous thromboses. He developed then a massive splenic infarct and an acute myocardial infarct, which required intensification of his anticoagulation, add of aspirin and high doses of corticosteroids. Three months later, he was explored for a latero-thoracic pain. Biology found an acute renal failure and microscopic haematuria. CT scan showed hypoperfusion of the left kidney, an ostial defect on renal artery and left hydronephrosis. Retrograde pyelography found a proximal ureteral stenosis. A dilatation with stenting failed, leading to a partial left ureteral resection. Histology confirmed ureteral segmental organized arterial thrombosis and venous thrombosis. Evolution was favourable with stabilization of creatinine level.

Urinary tract involvement is rarely described in antiphospholipid syndrome (APS). We report the case of a 40 year-old man with primitive APS who developed an arterial and venous unilateral ureteral ischemia revealed by painful unilateral hydronephrosis. The patient was on oral anticoagulation for six years because of two deep venous thromboses. He developed then a massive splenic infarct and an acute myocardial infarct, which required the intensification of his anticoagulation and high doses of corticosteroids. Three months later, he was explored for a latero-thoracic pain. Biology found an acute renal failure and microscopic haematuria. CT scan showed a hypoperfusion of the left kidney, an ostial defect on renal artery and a left hydronephrosis. Retrograde pyelography found a stenosis of the proximal ureter. A dilatation with stenting failed, leading to a partial left ureteral resection. Histology confirmed ureteral segmental organized arterial thrombosis and venous thrombosis. Evolution was favourable with stabilization of creatinine.

DOI: http://dx.doi.org/10.3126/jaim.v2i2.7659  

Journal of Advances in Internal Medicine 2013;02(02):78-80

Downloads

Download data is not yet available.
Abstract
554
PDF
262

Author Biography

Philippe Camparo, Service d’Anatomo-Pathologie, Hôpital Foch, 40 rue Worth, 92151, Suresnes

 

Published
2013-09-29
How to Cite
de Moreuil, C., Piette, A.-M., Hervé, J.-M., Camparo, P., Baglin, A.-C., Blétry, O., & Kahn, J.-E. (2013). An atypical hydronephrosis revealing urinary tract involvement in antiphospholipid syndrome. Journal of Advances in Internal Medicine, 2(2), 78-80. https://doi.org/10.3126/jaim.v2i2.7659
Section
Case Reports