Histopathology of catastrophic antiphospholipid syndrome-associated nephropathy in a SLE patient without concurrent lupus nephritis.

A 35-year-old African American male with a history of seizures, presented with nausea, vomiting, abdominal pain, thrombocytopenia (platelet count of 48,000) and acute renal failure (BUN/creatinine - 30/5.6). Urinalysis showed mild proteinuria and microscopic hematuria. He was diagnosed with systemic lupus erythematosus (SLE) on the basis of positive ANA, anti-dsDNA, arthritis, thrombocytopenia and hypocomplementemia fulfilling 5 of 11 SLE criteria (1). He also was positive for antibodies to cardiolipin, beta2-glycoprotein-I and lupus anticoagulant. ADAMTS13 level was lower than normal but not indicative of TTP.