ANTICOAGULATION AND LONGTERM OUTCOMES IN PATIENTS WITH RENAL ARTERY STENOSIS AND ANTIPHOSPHOLIPID SYNDROME

Background Our previous data [1],[2],[3] showed that renal artery stenosis (RAS) is more prevalent in antiphospholipid syndrome (APS) (26%) compared to the general hypertensive population (8%),and anticoagulation with INR≥3 was associated with initial reduction of chronic kidney disease (CKD) and hypertension. Objectives To characterise the long-term outcomes and associations with anticoagulant treatment for patients with renal artery stenosis and antiphospholipid syndrome. Methods We identified 37 patients with RAS and APS fulfilling Sapporo criteria [4]: anticardiolipin IgG/IgM titer>40 units or >99th percentile (or +lupus anticoagulant) on ≥2 occasions ≥6 weeks apart AND vascular thrombosis (or pregnancy morbidity). RAS was diagnosed by magnetic resonance angiography (MRA). Results 15 patients had APS alone and 22 APS associated with autoimmune conditions (13 lupus, 5 ANCA vasculitis, 4 mixed). Median age at RAS diagnosis was 48 years, 31/37 (83.8%) were female and median follow-up was 10.4 years. 25/37 (67.6%) had previous thrombosis. 7/37 (18.9%) had bilateral RAS, 3 artery occlusion. 6/37 (16.2%) had concurrent coeliac stenosis. Recanalization of RAS occurred after hydroxychloroquine in 3/37 and 9/37 (24.3%) underwent angioplasty +/− stenting. MRA was repeated in 11/37 (29.7%) after 2 years. 23/37 (62.2%) were anticoagulated, with 9/37 (24.3%) on antiplatelet therapy. 13/37 (35.1%) received hydroxychloroquine, 10/22 (45.5%) immunosuppressives and 18/37 (48.6%) antihypertensives. 9/37 (24.3%) died after a median of 10 years since RAS diagnosis. 21/37 (56.8%) developed CKD: 6 endstage renal failure (ESRD) and 15 with median eGFR 39 mls/min. Conclusions The majority of patients with RAS and APS were female, developed CKD and did not benefit from renal angioplasty. Anticoagulation was not associated with longterm reduction of ESRD or death, suggesting a non-thrombotic pathogenic process underlying RAS, such as intimal hyperplasia. Treatment of associated vascular risk factors and autoimmune disease is paramount. Anticardiolipin antibodies and renal MRA are useful screening tests for lupus patients with difficult blood pressure control. References S R Sangle, D P D9Cruz et al. Ann Rheum Dis 2003;62:999–1002. S R Sangle, D P D9Cruz et al. Rheumatology 2005;44:372–37 Jordan NP, Chaib A, Sangle S, D9Cruz DP. Arthritis Care and Research) 2013 Sipek-Dolnicar A, Hojnik M, Bozic B, Vizjak A. Clin Exp Rheumatol. 2002; 20:335–42. Disclosure of Interest None declared