12. Renal infarction as an initial presentation of systemic Lupus erythematosus in children

Mai Thanh Cong, Pham Thi Hong Khanh, Ha Thi Lieu, Nguyen Thi Thanh Nhàn, Tong Hai Yen, Nguyen Thanh Nam

Main Article Content

Abstract

Although systemic lupus erythematosus (SLE) has a high incidence of arterial and venous thrombosis, especially in patients with antiphospholipid antibodies (aPL), renal infarction is rarely reported and often misdiagnosed as other conditions. We report a case of a 15-year-old male child admitted to the hospital with abdominal pain, fever and arthritis. Computed tomography (CT) of the abdomen showed bilateral kidney infarction. Investigative tests performed confirmed that patient met the diagnostic criteria for SLE with positive antiphospholipid antibodies. The patient responded well when treated with anticoagulants, corticosteroids combined with hydroxychloroquine. Renal infarction can be the initial manifestation of systemic lupus erythematosus in children, requiring a comprehensive diagnostic approach to the causes of renal thrombosis for appropriate treatment.

Article Details

References

1. Bourgault M, Grimbert P, Verret C, et al. Acute renal infarction: a case series. Clin J Am Soc Nephrol. 2013; 8(3): 392-398. doi:10.2215/CJN.05570612.
2. Oh YK, Yang CW, Kim YL, et al. Clinical Characteristics and Outcomes of Renal Infarction. American Journal of Kidney Diseases. 2016; 67(2): 243-250. doi:10.1053/j.ajkd.2015.09.019.
3. Kuzmanovska DB, Sahpazova EM, Grujovska SJ, Trajkovski Z. Renal infarction in a child with systemic lupus erythematosus. Pediatr Nephrol. 2004; 19(6): 685-687. doi:10.1007/s00467-004-1454-8.
4. Brouwer JLP, Bijl M, Veeger NJGM, Kluin-Nelemans HC, van der Meer J. The contribution of inherited and acquired thrombophilic defects, alone or combined with antiphospholipid antibodies, to venous and arterial thromboembolism in patients with systemic lupus erythematosus. Blood. 2004; 104(1): 143-148. doi:10.1182/blood-2003-11-4085.
5. Petrovic G, Pasic S, Soldatovic I. Association of Antiphospholipid Antibodies with Clinical Manifestations in Children with Systemic Lupus Erythematosus. J Clin Med. 2023; 12(4): 1424. doi:10.3390/jcm12041424.
6. Huang CC, Lo HC, Huang HH, et al. ED presentations of acute renal infarction. Am J Emerg Med. 2007; 25(2): 164-169. doi:10.1016/j.ajem.2006.06.010.
7. Domanovits H, Paulis M, Nikfardjam M, et al. Acute renal infarction. Clinical characteristics of 17 patients. Medicine (Baltimore). 1999; 78(6): 386-394. doi:10.1097/00005792-199911000-00004.
8. Hazanov N, Somin M, Attali M, et al. Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation. Medicine (Baltimore). 2004; 83(5): 292-299. doi:10.1097/01.md.0000141097.08000.99.
9. Justiz Vaillant AA, Goyal A, Varacallo M. Systemic Lupus Erythematosus. In: StatPearls. StatPearls Publishing; 2023. Accessed January 6, 2024. http://www.ncbi.nlm.nih.gov/books/NBK535405/.
10. López-Pedrera C, Buendía P, Cuadrado MJ, et al. Antiphospholipid antibodies from patients with the antiphospholipid syndrome induce monocyte tissue factor expression through the simultaneous activation of NF-kappaB/Rel proteins via the p38 mitogen-activated protein kinase pathway, and of the MEK-1/ERK pathway. Arthritis Rheum. 2006; 54(1): 301-311. doi:10.1002/art.21549.
11. Knight JS, Kanthi Y. Mechanisms of immunothrombosis and vasculopathy in antiphospholipid syndrome. Semin Immunopathol. 2022; 44(3): 347-362. doi:10.1007/s00281-022-00916-w.
12. Associations with thrombosis are stronger for antiphosphatidylserine/prothrombin antibodies than for the Sydney criteria antiphospholipid antibody tests in SLE - PMC. Accessed January 6, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209767/.
13. Mulayamkuzhiyil Saju J, Leslie SW. Renal Infarction. In: StatPearls. StatPearls Publishing; 2023. Accessed January 6, 2024. http://www.ncbi.nlm.nih.gov/books/NBK582139/.
14. Barbhaiya M, Zuily S, Naden R, et al. The 2023 ACR / EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis & Rheumatology. 2023; 75(10): 1687-1702. doi:10.1002/art.42624.
15. Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019; 71(9): 1400-1412. doi:10.1002/art.40930.
16. Sisó A, Ramos-Casals M, Bové A, et al. Previous antimalarial therapy in patients diagnosed with lupus nephritis: influence on outcomes and survival. Lupus. 2008;17(4):281-288. doi:10.1177/0961203307086503.