Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan.
Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan.
Intern Med. 2023 Sep 15;62(18):2707-2713. doi: 10.2169/internalmedicine.0813-22. Epub 2023 Feb 1.
We experienced a 36-year-old man with lupus nephritis and antiphospholipid syndrome (APS) who received a donor kidney from his father. Twenty-two months after transplantation, at a time of poor adherence to immunosuppressants and warfarin, the patient developed sudden graft loss due to hemolytic uremic syndrome with rapid deterioration of renal function, thrombocytopenia, and hemolytic anemia. A kidney biopsy showed thrombotic microangiopathy (TMA) related to platelet thrombus formation; however, there was no recurrence of lupus and no findings suggestive of post-transplant rejection, so acute TMA associated with APS was thought to be the cause of the graft loss. This case highlights the importance of instructing patients with lupus nephritis to adhere to treatment with warfarin, a therapeutic drug for APS.
我们遇到了一位 36 岁的男性狼疮肾炎和抗磷脂综合征（APS）患者，他接受了来自父亲的供肾。移植后 22 个月，由于免疫抑制剂和华法林的依从性差，患者出现了溶血性尿毒症综合征，导致肾功能迅速恶化、血小板减少和溶血性贫血，从而导致移植物突然丧失。肾活检显示与血小板血栓形成相关的血栓性微血管病（TMA）；然而，没有狼疮复发的迹象，也没有提示移植排斥反应的发现，因此认为与 APS 相关的急性 TMA 是移植物丢失的原因。本病例强调了指导狼疮肾炎患者坚持使用华法林治疗的重要性，华法林是治疗 APS 的一种药物。
