acenocoumarol and Renal-Artery-Obstruction

We describe a 26-year-old white female with a history of Raynaud phenomenon, erythema nodosum, polyarthralgias, migraine, vertigo, seizures, transient ischemic attacks, one fetal loss, and false positive VDRL, who developed milk hypertension without overt lupus nephritis. She had positive antinuclear antibodies (ANA) and double-stranded deoxyribonucleic acid (dsDNA) antibodies. The lupus anticoagulant test (LAC) and cardiolipins antibodies (aCL) were positive. She was diagnosed as having a Systemic Lupus Erythematosus-like illness (SLE-like) with 'secondary' antiphospholipid syndrome (APS). Renal spiral computed tomography (CT) with intravenous (IV) contrast showed bilateral renal artery stenosis. Anticoagulation with acenocumarol was started. She became normotensive without antihypertensive drugs five months later. A follow-up renal spiral CT showed complete recanalization of both renal arteries, making thrombosis the more likely culprit pathology in the stenosis. After two years follow up the patient is normotensive. She remains on acenocumarol.

Topics: Acenocoumarol; Adult; Antibodies, Anticardiolipin; Antibodies, Antinuclear; Anticoagulants; Antiphospholipid Syndrome; DNA; Female; Humans; Hypertension; Lupus Coagulation Inhibitor; Raynaud Disease; Renal Artery; Renal Artery Obstruction; Tomography, X-Ray Computed

We report a case of embolism of the intrarenal arterial branches of a cardiac origin. The results of the urographic, ultrasound, ascending pyelography and laboratory work up prompted us to suspect the vascular nature of the condition. Its unilateral feature, involvement of the intrarenal arterial branches, and the coexisting mitral valve disease with atrial flutter advised conservative management with systemic anticoagulation.

Topics: Acenocoumarol; Atrial Flutter; Embolism; Female; Heparin; Humans; Middle Aged; Mitral Valve Stenosis; Renal Artery Obstruction