An atypical hydronephrosis revealing urinary tract involvement in antiphospholipid syndrome

Claire de Moreuil, Anne-Marie Piette, Jean-Marie Hervé, Philippe Camparo, Anne-Catherine Baglin, Olivier Blétry, Jean-Emmanuel Kahn

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

Keywords

Antiphospholipid syndrome; Thrombosis; Hydronephrosis; Acute renal failure

Full Text:

PDF


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

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.


Copyright (c)

Indexed in Google Scholar, Ulrich’s International Periodical Directory, Summon discovery service, ProQuest, ICMJE, Genamics Gale/Cengage Learning, Thomson-Gale, JournalTOC, Science Central, EBSCOhost™, WorldCat, LibToc, Medical Journals Links, HINARI, Falvey Memorial Library (Villanova University),  Sciencegate, Research Bible