An atypical hydronephrosis revealing urinary tract involvement in antiphospholipid syndrome
Journal Title: Journal of Advances in Internal Medicine - Year 2013, Vol 2, Issue 4
Abstract
Urinary tract involvement is rarely described in antiphospholipid syndrome (APS). We report the case of a 40 year-old man with primitive APS who developed an arterial and venous unilateral ureteral ischemia revealed by painful unilateral hydronephrosis. The patient was on oral anticoagulation for six years because of two deep venous thromboses. He developed then a massive splenic infarct and an acute myocardial infarct, which required the intensification of his anticoagulation and high doses of corticosteroids. Three months later, he was explored for a latero-thoracic pain. Biology found an acute renal failure and microscopic haematuria. CT scan showed a hypoperfusion of the left kidney, an ostial defect on renal artery and a left hydronephrosis. Retrograde pyelography found a stenosis of the proximal ureter. A dilatation with stenting failed, leading to a partial left ureteral resection. Histology confirmed ureteral segmental organized arterial thrombosis and venous thrombosis. Evolution was favourable with stabilization of creatinine.
Authors and Affiliations
Claire de Moreuil*| Service de Médecine interne, CHRU de Brest, Hôpital La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France, Anne-Marie Piette| Service de Médecine interne, Hôpital Foch, 40 rue Worth, 92151, Suresnes, France, Jean-Marie Hervé| Service d’Urologie, Hôpital Foch, 40 rue Worth, 92151, Suresnes, France, Philippe Camparo| Service d’Anatomo-Pathologie, Hôpital Foch, 40 rue Worth, 92151, Suresnes, France, Anne-Catherine Baglin| Service d’Anatomo-Pathologie, Hôpital Foch, 40 rue Worth, 92151, Suresnes, France, Olivier Blétry| Service de Médecine interne, Hôpital Foch, 40 rue Worth, 92151, Suresnes, France, Jean-Emmanuel Kahn| Service de Médecine interne, Hôpital Foch, 40 rue Worth, 92151, Suresnes, France
Keywords
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- DOI http://dx.doi.org/10.3126/jaim.v2i2.7659
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