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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">Primary Antiphospholipid Syndrome &#40;primary APS&#41; is an illness that is characterised by thrombotic phenomena&#44; which are due to the presence of antiphospholipid antibodies&#46; In 25&#37; of cases the kidneys can be affected&#59; this can present as progressive kidney failure&#44; proteinuria&#44; sediment changes&#44; renal infarction&#44;<span class="elsevierStyleSup">1&#44;2</span> and less commonly&#44; acute renal failure&#46;</p><p class="elsevierStylePara">We would like to present the following case&#58; female patient aged 65 years diagnosed with primary APS 20 years ago&#46; Her personal history included several miscarriages&#44; bilateral deep vein thrombosis&#44; recurrent thrombophlebitis and lacunar stroke&#46; Before she was admitted&#44; her creatinine level was 1mg&#47;dl&#44; platelet count was 166&#44;000&#47;mm<span class="elsevierStyleSup">3</span> and she was being treated with acenocoumarol&#46;</p><p class="elsevierStylePara">She was admitted for symptoms of acute cholecystitis&#44; for which surgery was required&#44; and during post-operative period she experienced a fever of 38&#186; C&#44; lumbar pain and oligoanuria&#46;</p><p class="elsevierStylePara">An analysis was performed that recorded an Hb level of 9&#46;3g&#47;dl&#44; Ht at 26&#37;&#44; platelets 66&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; creatinine 8mg&#47;dl&#44; urea 112mg&#47;dl&#44; K 4&#46;8mg&#47;dl&#44; Ca 7&#46;8mg&#47;dl&#44; LDH 790 and CRP 280mg&#47;dl&#46;</p><p class="elsevierStylePara">The test showed positive for anti beta-2 glycoprotein antibodies &#40;55u&#47;ml&#41;&#44; lupus anticoagulant &#40;88s&#41; and anticardiolipine IgG &#40;66u&#47;ml&#41;&#59; the rest showed no changes&#46;</p><p class="elsevierStylePara">Systematic urine analysis&#58; proteinuria&#44; 0&#46;7-0&#46;9g&#47;day&#59; microhaematuria&#59; and leukocyturia with granular casts&#46;</p><p class="elsevierStylePara">Obstructive pathology and renal vascular pathology was ruled out with an abdominal CT&#46;</p><p class="elsevierStylePara">Evolution&#58; thrombotic microangiopathy was detected from the renal biopsy&#46; Eight plasmapheresis sessions were administered in 17 days and the diuresis recovered progressively&#44; although haemodialysis was still necessary during the first month&#46; The patient was discharged and the plasmapheresis sessions became less frequent &#40;figure 1&#41;&#46;</p><p class="elsevierStylePara">Three months later&#44; the patient was admitted again due to decreased renal function associated with abdominalgia&#44; choroidal ischaemia and positive antiphospholipid antibody titres&#46; The profile was interpreted as a relapse of the disease and plasmapheresis sessions were started again and administered during four months&#44; which led to improvement in renal function and the ocular condition&#46;</p><p class="elsevierStylePara">One year later&#44; the platelets stabilised&#44; the creatinine descended slowly &#40;figure 2&#41;&#44; and the antiphospholipid antibody titres were normal&#59; there was no new thrombotic events&#46;</p><p class="elsevierStylePara">The treatment of choice for primary APS is not well-defined<span class="elsevierStyleSup">2</span> and varies according to the clinical presentation&#46; Some experts recommend high doses of anticoagulants&#44;<span class="elsevierStyleSup">3</span> while others support the use of antiplatelet drugs or prophylactic anticoagulants in low doses&#46; Other less successful treatments have used immunosuppressors and corticosteroids&#46;<span class="elsevierStyleSup">3</span> For patients on anticoagulants who suffer thrombotic events that severely affect the kidneys and&#47;or other organs&#44; plasmapheresis is an option&#44;<span class="elsevierStyleSup">4</span> as it was in our case&#46;</p><p class="elsevierStylePara"><a href="grande&#47;18718078&#95;f1&#95;p277&#46;jpg" class="elsevierStyleCrossRefs"><img src="18718078_f1_p277.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;18718078&#95;f2&#95;p277&#46;jpg" class="elsevierStyleCrossRefs"><img src="18718078_f2_p277.jpg"></img></a></p><p class="elsevierStylePara">Figure 2&#46; </p>"
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Antiphospholipid syndrome and thrombotic microangiopathy
Síndrome antifosfolípido y microangiopatía trombótica asociados
O.. Fikri Benbrahima, F.. Levya, J.J.. Santos Barajasa, M.L.. Carrasco Pradoa
a Servicio de Nefrología, Complejo asistencial de Burgos, Burgos, Burgos, España,
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">Primary Antiphospholipid Syndrome &#40;primary APS&#41; is an illness that is characterised by thrombotic phenomena&#44; which are due to the presence of antiphospholipid antibodies&#46; In 25&#37; of cases the kidneys can be affected&#59; this can present as progressive kidney failure&#44; proteinuria&#44; sediment changes&#44; renal infarction&#44;<span class="elsevierStyleSup">1&#44;2</span> and less commonly&#44; acute renal failure&#46;</p><p class="elsevierStylePara">We would like to present the following case&#58; female patient aged 65 years diagnosed with primary APS 20 years ago&#46; Her personal history included several miscarriages&#44; bilateral deep vein thrombosis&#44; recurrent thrombophlebitis and lacunar stroke&#46; Before she was admitted&#44; her creatinine level was 1mg&#47;dl&#44; platelet count was 166&#44;000&#47;mm<span class="elsevierStyleSup">3</span> and she was being treated with acenocoumarol&#46;</p><p class="elsevierStylePara">She was admitted for symptoms of acute cholecystitis&#44; for which surgery was required&#44; and during post-operative period she experienced a fever of 38&#186; C&#44; lumbar pain and oligoanuria&#46;</p><p class="elsevierStylePara">An analysis was performed that recorded an Hb level of 9&#46;3g&#47;dl&#44; Ht at 26&#37;&#44; platelets 66&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#44; creatinine 8mg&#47;dl&#44; urea 112mg&#47;dl&#44; K 4&#46;8mg&#47;dl&#44; Ca 7&#46;8mg&#47;dl&#44; LDH 790 and CRP 280mg&#47;dl&#46;</p><p class="elsevierStylePara">The test showed positive for anti beta-2 glycoprotein antibodies &#40;55u&#47;ml&#41;&#44; lupus anticoagulant &#40;88s&#41; and anticardiolipine IgG &#40;66u&#47;ml&#41;&#59; the rest showed no changes&#46;</p><p class="elsevierStylePara">Systematic urine analysis&#58; proteinuria&#44; 0&#46;7-0&#46;9g&#47;day&#59; microhaematuria&#59; and leukocyturia with granular casts&#46;</p><p class="elsevierStylePara">Obstructive pathology and renal vascular pathology was ruled out with an abdominal CT&#46;</p><p class="elsevierStylePara">Evolution&#58; thrombotic microangiopathy was detected from the renal biopsy&#46; Eight plasmapheresis sessions were administered in 17 days and the diuresis recovered progressively&#44; although haemodialysis was still necessary during the first month&#46; The patient was discharged and the plasmapheresis sessions became less frequent &#40;figure 1&#41;&#46;</p><p class="elsevierStylePara">Three months later&#44; the patient was admitted again due to decreased renal function associated with abdominalgia&#44; choroidal ischaemia and positive antiphospholipid antibody titres&#46; The profile was interpreted as a relapse of the disease and plasmapheresis sessions were started again and administered during four months&#44; which led to improvement in renal function and the ocular condition&#46;</p><p class="elsevierStylePara">One year later&#44; the platelets stabilised&#44; the creatinine descended slowly &#40;figure 2&#41;&#44; and the antiphospholipid antibody titres were normal&#59; there was no new thrombotic events&#46;</p><p class="elsevierStylePara">The treatment of choice for primary APS is not well-defined<span class="elsevierStyleSup">2</span> and varies according to the clinical presentation&#46; Some experts recommend high doses of anticoagulants&#44;<span class="elsevierStyleSup">3</span> while others support the use of antiplatelet drugs or prophylactic anticoagulants in low doses&#46; Other less successful treatments have used immunosuppressors and corticosteroids&#46;<span class="elsevierStyleSup">3</span> For patients on anticoagulants who suffer thrombotic events that severely affect the kidneys and&#47;or other organs&#44; plasmapheresis is an option&#44;<span class="elsevierStyleSup">4</span> as it was in our case&#46;</p><p class="elsevierStylePara"><a href="grande&#47;18718078&#95;f1&#95;p277&#46;jpg" class="elsevierStyleCrossRefs"><img src="18718078_f1_p277.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;18718078&#95;f2&#95;p277&#46;jpg" class="elsevierStyleCrossRefs"><img src="18718078_f2_p277.jpg"></img></a></p><p class="elsevierStylePara">Figure 2&#46; </p>"
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Article information
ISSN: 20132514
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2021 October 55 52 107
2021 September 37 34 71
2021 August 38 38 76
2021 July 60 34 94
2021 June 37 22 59
2021 May 69 30 99
2021 April 110 65 175
2021 March 61 26 87
2021 February 69 23 92
2021 January 33 19 52
2020 December 24 15 39
2020 November 31 14 45
2020 October 17 12 29
2020 September 22 10 32
2020 August 36 12 48
2020 July 30 7 37
2020 June 27 9 36
2020 May 38 13 51
2020 April 33 15 48
2020 March 38 12 50
2020 February 43 18 61
2020 January 37 14 51
2019 December 31 22 53
2019 November 35 20 55
2019 October 28 7 35
2019 September 33 10 43
2019 August 14 10 24
2019 July 32 27 59
2019 June 21 7 28
2019 May 23 12 35
2019 April 61 27 88
2019 March 29 23 52
2019 February 26 8 34
2019 January 34 23 57
2018 December 51 24 75
2018 November 89 9 98
2018 October 77 10 87
2018 September 53 10 63
2018 August 49 10 59
2018 July 35 8 43
2018 June 32 8 40
2018 May 42 13 55
2018 April 45 7 52
2018 March 35 5 40
2018 February 18 5 23
2018 January 37 4 41
2017 December 42 8 50
2017 November 17 9 26
2017 October 30 6 36
2017 September 29 12 41
2017 August 32 9 41
2017 July 33 11 44
2017 June 30 8 38
2017 May 50 13 63
2017 April 35 7 42
2017 March 39 12 51
2017 February 32 8 40
2017 January 22 3 25
2016 December 46 7 53
2016 November 50 7 57
2016 October 77 9 86
2016 September 92 1 93
2016 August 103 1 104
2016 July 114 4 118
2016 June 101 0 101
2016 May 123 0 123
2016 April 58 0 58
2016 March 54 0 54
2016 February 79 0 79
2016 January 83 0 83
2015 December 93 0 93
2015 November 51 0 51
2015 October 59 0 59
2015 September 40 0 40
2015 August 54 0 54
2015 July 49 0 49
2015 June 33 0 33
2015 May 44 0 44
2015 April 7 0 7
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Are you a health professional able to prescribe or dispense drugs?