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Antiphospholipid Syndrome Associated with Lupus Nephritis in a Resource-Poor Setting: A Case Report in Orlu, Nigeria

Received: 24 May 2017     Accepted: 14 June 2017     Published: 24 July 2017
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Abstract

The incidence of antiphospholipid syndrome (APS) in Nigeria is not well-defined. Concomitant occurrence of APS and systemic lupus erythematosus (SLE) is rare in Nigeria. Documented here is a case of APS associated with SLE, complicated by lupus nephritis, in a young woman in Nigeria. Patient was a 31-year-old woman on evaluation for 2 consecutive mid-trimester pregnancy losses, each preceded by a history of leg swelling and passage of blood in urine. Two of her sisters, about her age, have a similar history of recurrent mid-trimester pregnancy losses. Her blood pressure was normal. She has proteinuria +++, 24-hour urine protein 2942mg, and positive serology results for ANA, dsDNA, antiphospholipid antibody, and lupus anticoagulant. She was placed on Aspirin and Prednisolone, among others. Repeat urine protein was 1242mg/day at 4 weeks and 419mg/day at 12 weeks on follow-up. This case report highlights the need for consideration of the possibility of APS in association with SLE in the evaluation of miscarriages and proteinuric diseases in pregnancy.

Published in Cardiology and Cardiovascular Research (Volume 1, Issue 3)
DOI 10.11648/j.ccr.20170103.14
Page(s) 91-93
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Antiphospholipid Syndrome, Systemic Lupus Erythematosus, Lupus Nephritis, Miscarriage, Proteinuria in Pregnancy, Hematuria in Pregnancy, Nigeria

References
[1] Franco J-S, Molano-González N, Rodríguez-Jiménez M, Acosta-Ampudia Y, Mantilla RD, Amaya-Amaya J, et al. (2014) The Coexistence of Antiphospholipid Syndrome and Systemic Lupus Erythematosus in Colombians. PLoS ONE 9 (10): e110242. https://doi.org/10.1371/journal.pone.0110242
[2] Adelowo OO, Oguntona S. Anti-Phospholipid Syndrome in Nigeria: Report of Five Cases. East African Medical Journal Vol. 86 No. 2 February 2009.
[3] Adelowo OO, Bello MKN (2014) Systemic Autoimmune Diseases: Not So Rare in Black Africans. Rheumatology (Sunnyvale) 4: 130. doi: 10.4172/2161-1149.1000130.
[4] Erre GL, Bosincu L, Faedda R, Fenu P, Masala A, Sanna M, Taras L, Longu MG, Piras M, Soro G, Satta AE, Passiu G. Antiphospholipid syndrome nephropathy (APSN) in patients with lupus nephritis: a retrospective clinical and renal pathology study. Rheumatol Int. 2014 Apr; 34 (4): 535-41.
[5] Negrini S, Pappalardo F, Murdaca G, Indiveri F, Puppo F. The antiphospholipid syndrome: from pathophysiology to treatment. Clin Exp Med. 2016 Jun 22.
[6] Todd J. Stanhope, Wendy M. White, Kevin G. Moder, Andrew Smyth, Vesna D. Garovic. Obstetric Nephrology: Lupus and Lupus Nephritis in Pregnancy. CJASN December 07, 2012 vol. 7 no. 12 2089-2099. doi: 10.2215/CJN.12441211.
[7] Bassam Alchi, Meryl Griffiths, David Jayne; What nephrologists need to know about antiphospholipid syndrome. Nephrol Dial Transplant 2010; 25 (10): 3147-3154. doi: 10.1093/ndt/gfq356.
[8] Steven J. Wagner, Iasmina Craici, Darcy Reed, Suzanne Norby, Kent Bailey, Heather J. Wiste, Christina M. Wood, Kevin G. Moder, Kimberly P. Liang, Kelly V. Liang, Carl Rose, Tomas Rozkos, Michal Sitina, Joseph P. Grande, and Vesna D. Garovic. Maternal and Fetal Outcomes in Pregnant Patients with Active Lupus Nephritis. Lupus. 2009 Apr; 18 (4): 342–347. doi: 10.1177/0961203308097575.
[9] Marcantoni C, Emmanuele C, Scolari F. Renal involvement in primary antiphospholipid syndrome. J Nephrol. 2016 May 19.
[10] Saba Kiremitci and Arzu Ensari, “Classifying Lupus Nephritis: An Ongoing Story,” The Scientific World Journal, vol. 2014, Article ID 580620, 10 pages, 2014. doi: 10.1155/2014/580620.
[11] Robert W. Putsch, III and Marlie Joyce. Chapter 229 Dealing with Patients from Other Cultures. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.
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  • APA Style

    Ernest Ndukaife Anyabolu. (2017). Antiphospholipid Syndrome Associated with Lupus Nephritis in a Resource-Poor Setting: A Case Report in Orlu, Nigeria. Cardiology and Cardiovascular Research, 1(3), 91-93. https://doi.org/10.11648/j.ccr.20170103.14

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    ACS Style

    Ernest Ndukaife Anyabolu. Antiphospholipid Syndrome Associated with Lupus Nephritis in a Resource-Poor Setting: A Case Report in Orlu, Nigeria. Cardiol. Cardiovasc. Res. 2017, 1(3), 91-93. doi: 10.11648/j.ccr.20170103.14

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    AMA Style

    Ernest Ndukaife Anyabolu. Antiphospholipid Syndrome Associated with Lupus Nephritis in a Resource-Poor Setting: A Case Report in Orlu, Nigeria. Cardiol Cardiovasc Res. 2017;1(3):91-93. doi: 10.11648/j.ccr.20170103.14

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  • @article{10.11648/j.ccr.20170103.14,
      author = {Ernest Ndukaife Anyabolu},
      title = {Antiphospholipid Syndrome Associated with Lupus Nephritis in a Resource-Poor Setting: A Case Report in Orlu, Nigeria},
      journal = {Cardiology and Cardiovascular Research},
      volume = {1},
      number = {3},
      pages = {91-93},
      doi = {10.11648/j.ccr.20170103.14},
      url = {https://doi.org/10.11648/j.ccr.20170103.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20170103.14},
      abstract = {The incidence of antiphospholipid syndrome (APS) in Nigeria is not well-defined. Concomitant occurrence of APS and systemic lupus erythematosus (SLE) is rare in Nigeria. Documented here is a case of APS associated with SLE, complicated by lupus nephritis, in a young woman in Nigeria. Patient was a 31-year-old woman on evaluation for 2 consecutive mid-trimester pregnancy losses, each preceded by a history of leg swelling and passage of blood in urine. Two of her sisters, about her age, have a similar history of recurrent mid-trimester pregnancy losses. Her blood pressure was normal. She has proteinuria +++, 24-hour urine protein 2942mg, and positive serology results for ANA, dsDNA, antiphospholipid antibody, and lupus anticoagulant. She was placed on Aspirin and Prednisolone, among others. Repeat urine protein was 1242mg/day at 4 weeks and 419mg/day at 12 weeks on follow-up. This case report highlights the need for consideration of the possibility of APS in association with SLE in the evaluation of miscarriages and proteinuric diseases in pregnancy.},
     year = {2017}
    }
    

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    AB  - The incidence of antiphospholipid syndrome (APS) in Nigeria is not well-defined. Concomitant occurrence of APS and systemic lupus erythematosus (SLE) is rare in Nigeria. Documented here is a case of APS associated with SLE, complicated by lupus nephritis, in a young woman in Nigeria. Patient was a 31-year-old woman on evaluation for 2 consecutive mid-trimester pregnancy losses, each preceded by a history of leg swelling and passage of blood in urine. Two of her sisters, about her age, have a similar history of recurrent mid-trimester pregnancy losses. Her blood pressure was normal. She has proteinuria +++, 24-hour urine protein 2942mg, and positive serology results for ANA, dsDNA, antiphospholipid antibody, and lupus anticoagulant. She was placed on Aspirin and Prednisolone, among others. Repeat urine protein was 1242mg/day at 4 weeks and 419mg/day at 12 weeks on follow-up. This case report highlights the need for consideration of the possibility of APS in association with SLE in the evaluation of miscarriages and proteinuric diseases in pregnancy.
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Author Information
  • Department of Medicine, Imo State University Teaching Hospital, Orlu, Nigeria

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