REVERSIBLE RENAL-FAILURE DUE TO THE ANTIPHOSPHOLIPID ANTIBODY SYNDROME, PREECLAMPSIA AND RENAL THROMBOTIC MICROANGIOPATHY

A 27-year-old Caucasian female, with a past history of recurrent spont aneous abortions, was admitted with pre-eclampsia at 26 weeks' gestati on during her sixth pregnancy. She was previously known to have antiph ospholipid antibodies since her fifth abortion, but had no clinical or serological evidence of systemic lupus erythematosus. A small-for-dat es infant was delivered by emergency Caesarean section at 27 weeks for poor placental blood flow and fetal distress. She was transferred to the renal unit on the sixth post partum day with pulmonary edema, hype rtension, disseminated intravascular coagulation and acute renal failu re. Renal biopsy showed lesions compatible with thrombotic microangiop athy with diffuse glomerular necrosis. She was plasma exchanged and re mained dialysis dependent for 7 months. Antiphospholipid antibodies we re present in high titres and were the presumed cause of her acute ren al failure. The patient now has stable renal function with a creatinin e clearance of 30 ml/min for over two years. The late recovery of rena l function is unique in the above circumstances.