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1 1387 '!(/89 #$/!!"# *** ** *.."#!! *."#!! %&'() )"* # **."#!! %&' )"* # *** 12%./ 0 '( % ) *+,$ - %&! $ #!" 3-7 $;=2 9$ 6;&<% 9$ ; % - & ) *+ )3-4 )$% - 0 $> + $ 56% 4 7 %&! >& %.7+ -6% '=$7 );0% >&- > )56% )- $;07 )3 B& - ' % 1$! - A )*+ "% - ); 3 ',?@0 6;&<% 9$ 7 ->- 'ISN/RPS 2003 % 1$! $/ )-F"@ ( - '1"$E %&! D$ C & )0 ); 0> > H7! - I$.$75 - #!" > 0G3; &.5 M L*N 7 0 SPSS )0 G 7 L@"0 t & )+ &JK0.7 - IV (R+ ' % 1$! S 9$Q$. H$7 %&! '3- %31/ '(P > 0/05) %&! 0G3; 7 /& & % 1$! S > + ; 9- (P = 0/434) *+ "% - 0> W? - %&! & % 1$! 0G3; '(P = 0/904) %&! 0G3; 7 /& & ;)7- #!" Z[ 9- G & 0G3; 7 /& & (3^"$ '> _0&) 3- - F\R] $ )7,0 &!.(P = 0/001) 7-7,0 &! '%&! 3- )*+ "% - ` BG5 & a =; - $ ;&<% 9$ $> $3 + 1M7 F; %&! - b -0 0G3; 7 /& - ' % 1$! - R_0 M&] d7 [ >&- > 0 & +0 D3+ I,0 DG% - WNc $ 7 /&.$3 )56% % 1$! 3-7 D _0& 86/9/18 87/1/20.! "#$! % "&! %' #( )*$ "#!! alisadoogh@yahoo.com '_] h&c *] +7 N!c 7, ;f&/ 7, ;7 3 7, Q-0 7, /.' -*',(

2 " $T "?-& -< # " # 0$& ESRD (End Stage Renal Disease) SLE -/ (5) $& I\ -& # Y-& % (Systemic Lupus Erythematosus) $ F<&= N # $/ N 2&C = $0 W-_ b># $ /0= / $.I $#-7!" # $/ *+", -.$%& ' () 21& 0$& $ $ # & % +& -N.,7 $ /.(1) /0$& ESRD $ -7 -< "9 cdh.- -. I #e / /&= 8 $ $ 9# ;)< (Anti phospholipid syndrome) -.0$& ;)<& $,7 + # Tektonidou I #e. L0 $#-7» /C d R& # = $+ 2>? 9# 9 / 9# # (-+& AB # $>#-C =D&#-) $/ «$,7$ # $ $ ) $ F<&= E # = $+ 2>? $ " $ &\ i? -X = 7 L# $ - $,7 $ W-U # $#-7 2>? $, $ G. DK& "H I&= # %50 = I N -..(2) 0 % (0 L0 & % # - DK& $,7$ $#-7 # 9# & ]7 '-> -K -j $ 8T& IB L/ < $/ 0.S RD& T -F = $ F<&= T - $# (# ) SLE (U ) / L0 H # 0$& $#-7.(3) T -@0 = $+ /C $#-7 = $+ $ " ' $ -. L0 -. -X # -7 -= 0$& SLE W- X -8# # Moroni.(6) 0 I&= T ' /& G. ) -& # Y-& 2"C Z 7C R& 2004! /k RD& " '.(4) -> $ i?» /C d $< #e + ]7 # & %25 \ -7 RD& & $,7 CRF -< -E I\ '9& $ (" &\& $ ) (Chronic Renal Failure) W& - $ «.0$& ]#-C W@ "C ^># $& 0 9 =.(3) 0$& " # W@ - $#-7 = $0 " W-_ ac < '9& `-& " "

3 $< #e R& 2004! + # Ruiz <.- 2> -s ' #- -U» /C d % «$ $" B #.,7 $ $ $ > L#-. D $.(10) /0 -< -& # Y-& # & $< #e / & < % = 80 - L< % t1 # $#-7 b0 $ - p I #e " ' b # $/ 8uRC `D - $ -7 RD& T7H $+0\ "C LF< # v- \.8 % ! $ # - $@EB& n I #e () v- \ ! = -. -> " $ d # w0 % 0- (# WHO T9 0T $ -7 (Worlds Health Organization) $ /0 ' G. L0 L ;)< $F I) = " $ *, # 0 #^9 $ /0 ' LF<&= $CRn S j#-7 $ F<&= # $/ & # $/= \ # -. -> $/= & 0 - $# = $0 " W-_ $ -7 9 ISN/RPS (International Society of Nephrology/ Renal Pathology Society) 2003,7 $ / = $0 " W-_ 8 # -> $ - & L& 173 & $,7 $ 9# WDU - T/ $ -7 " %- - +" $&& # $>#-C ac.(3) 7& Tl $#-7» /C d -F I #e 2002! «- I #e + # Dagous 0 % R& -> " $ d $ 114 # m b = 2B& N # L- N $ \ # $& ]7 $#-7 $ i? & -X = /@& n $#-7 /k # L- G. $ Le# " o 8RC =#- $#-7 $# `D /9 AB # $-0 =D&#- 0 $nd # =D&#- &\ =#-.(7) G. $ & W-U & /k R& 2003! $#-7 #-» /C d + # Olguin " # # 0 % «B@ & pr - $#-7 RD& 5 " -+"C DT # -, G. $ $D- & $#-7.(8) - (\.,7 + # Miranda " # $< #e " $» /C R& 1994! =D&#- i? # $ % $ # - «$#-&". # $#-&". =D&#- 9# E S 0.(9) < -7 W0 1

4 1381! `-& L& $ -> " $ d - \ 1384 # WCRn $ 2 & 2 -. I #e = T $+0\ ~ -X & -_& \ L& $> & 73 # 0 p? $F = -7 7 " $ G D 9& () - \ $ /0' $/= - $"E& 7 $ - WH & 66 # - & $ - # = w0 8 # $/= - "E& G 8 L> =.-. -> %& $ - & ($#-7 ) - - 9& L#- L0 - -F $F I) = -X & L#- G - # 0 #^9 () v- \ & $ F<&= # $/ $- o-) I #e > $ - # -X -X & $ -_& /&= L0 % < -7 $&\ `D -< -. -> /DC -_&.0 $#-7 # $ - $ -7 b */9 #.-. % /0 -X & -_& # WCRn `-& W-_ 9# C 9# SPSS-12 & \ - " # L \& " $ G $#-7 &= - # (SPSS, Inc. Chicago, IL) " $ &= - Cr (Creatinine) chi-squre, Independent sample test & 2&0,7 $ $ i? -> & 2"d & P < 0/05 $/@& ce.-. # LAC (Lupus Anti Coagulant) G. $ 9# ACL (Anti Cardio Lipin), $ % $ -7 & 66 # - I #e $/ A &. = %88 # -& T %12 0 =.! 22 " $ &= T $/= & T " $ G & 66 W-_ (%31/8) $ -7 b & 21 T/ -. -> =D&#- L/ < $>#-C 8RC B =D&#- # \_& $>#-C y? 2&0 $+ $BC # =D&#- # / # $-0 =D&#- $D&D&#- m - -F. # $+ + CT (Computed Tomography) `-& $-. MRI (Magnetic Resonance Imaging) -#-./0 $#-7 R # (%66/6) & 44 IV R `-& - V # II R # (%12/1) & 8 \ III.0 L (%10/6) & 7 $ - $#-7 & 12 & 66 b $ - & 4 IV b $ -7 & # # II b $ - & 3 III V b $ -7 $ - $#-7 &. L0 z + # -" i? 2+0 WCRn > L#- # {& $ - L0 D?1& $/7" =G WCRn T 0.!? }-0 #-& - `-& WCRn #^9.- # #^9-7 &.-. #^9.9 9# $ #d& G $/= # WCRn -7 & 75 = '- 0 = 7

5 T = $+ # =D&#- $/ 8RC W-_ & 45 $-n =.& G $#-7 W-_ (%85/7) & 6-7 IV R /k /0 $#-7 W-_ T = (%14/2) & 1 T/ # 0 b0 -< (%71/1) $ $ -7 W-_ &\ $#-7 `-& $ -7 b0 -< 2 -= (%89/3) \ -F & 59 # 0 G.(1!#9) IV R.(2!#9) /0 $/ 8RC L#-. (Cr) /- $&- ce F&,-. ('( )*) $%!"#.2 2 ^ $#-7 DK& $7/& $7/& DK& $/ 8RC 2 ^9 L0 $ - $"H W1)<&. L0 -Å 3!#9 $ -7 b = - '- $#-7 W-_ &\ 9# # -7 &\ $#-7 W-_ W-_ # L#-. # 0/7 ( ± 0/16) $.& 0/8 ( ± 0/17) $#-7.1 $7/& 4 (%57/1) $#-7 DK& 3 (%42/9) II 4 (%50) 4 (%50) III $ -7 b 32 (%72/7) 12 (%27/2) IV 5 (%71/4) 2 (%28/5) V # $ -7 $&\ (P > 0/05) W-_ & 21 & " $ &= Cr $&- ce $#-7 DK& $ LAC (%38) & 8 $#-7 $,7 $ i? \ # (P = 0/434) $#-7 &\ W-_ 9# # T/ # < $/@& W#7 (P = 0/904) # ($+ # =D&#-) W#7 $#-7 $/ 8RC &\ W-_ 9#.(P = 0/001) 0 $/@&. $7/& $ LAC (%62) & 13 # $, $ (%33/3) & 7 /k $ ACL (%66/6) & 14 # DK& (ACL) (%42/8) 9 \ & 21. $7/& 12 # /0 ACL # LAC $ # -./0 $ # = S (%57/1) (%10/6) & 7 T/ L0 $ - & 66 56, 3% "4*,% II III IV V >#!"# ;< 3% =% % 47 ( LAC ACL ?@ $ () 22 ) 58 8 $ -7 RD& (& 66) L0 $ - <

6 " i? $nd # L AD-& /0. 0 $,7$ $ -7 $&\ I #e " $ &= - Cr \& # $#-7 I #e -& $nd /k.(12-14) 9# -X pr \ 0. # $ -7 b $nd -? I #e z& $#-7 &\ 9# T/ # L0 z \ < I #e -< -7 V R $#-7 b># I #e $9 =.(153-16) AD-& $ 8RC T/ < I #e # =D&#-) $ -7 N $/ $#-7 W-_ &\ 9# # ($ # /@& `D L0 \ L0 % <& I #e,7$ i? I #e.(63-7) -7 $#-7 &\ 9# # $ z& < /@& `D $ $?.(11),7$ L0 z \ I #e $- 9# I #e -< ' $F 9& " $ G &\ W-_ 9# # $ = 1381! = I () v- \ $ /0 -%& # = D - $"E& ! `-& G I #e G & ! -> $ - b& - - & $nd $#-7 &\ 9# $,7 $ b 9# -X pr L $nd $#-7 -? I #e &.(8-9) 0$& T/<.& $ $,7 $ 9# `D & 0 % -< &=!n L/ I #e -< C -7 # $ D $#-7 &\ b># (ACL, LAC) I #e B& $ H? G $ - " /0' $ -7 RD& " $ / $#-7 &\ W-_ ;)< W-_ 9# WH # \ m@& 0\ $-n =.0 # $ /0'.- W-_ 9# /0' = " $ $ /0' $#-7 W-_ 9# -=.,7 $ -. $? $ -7 =#- "C 0 W#7& L0 # $,7 $ i? $#-7 $ F<&=!@& 8 T `D annexin-v, anti-phosphatidylserine-ab, /&.0$ $ - # ACL-IgA,7 $ $ - L 2 L0$& % $T&= $ $/ $" - L $7/&. n $ LD T ;)< > LF<&= 0 $#-7 $>#-C W@ =/ " 2 D&#- #- -F 1386 * /86 / (

7 $? $ -7 $#-7 9# # $,7 $ i? # =.-F L <& $nd v\9 $#-7 W-_ -T.0 L%/. $1)< /$& \"& m@& 0\ 0 $7/& $ L/ > # cdh & - -N w< D&#- $>#-C y? N 9# $/@& `D -? I #e &\ i? $+ # =D&#- $/ 8RC 1. Kasper DL, Braunwald E, Hauser S, Longo D, Jameson JL, Fauci AS. Harrison's Principles of Internal Medicine. 16th ed. New York McGraw- Hill Professional; Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome report of an international workshop. Arthritis Rheum 1999; 42(7) Moroni G, Ventura D, Riva P, Panzeri P, Quaglini S, Banfi G, et al. Antiphospholipid antibodies are associated with an increased risk for chronic renal insufficiency in patients with lupus nephritis. Am J Kidney Dis 2004; 43(1) Goldman L, Ausiello DA, Newman J, Foster E. Cecil Textbook of Medicine. 22nd ed. New York W.B. Saunders; Griffiths MH, Papadaki L, Neild GH. The renal pathology of primary antiphospholipid syndrome a distinctive form of endothelial injury. QJM 2000; 93(7) Tektonidou MG, Sotsiou F, Nakopoulou L, Vlachoyiannopoulos PG, Moutsopoulos HM. Antiphospholipid syndrome nephropathy in patients with systemic lupus erythematosus and antiphospholipid antibodies prevalence, clinical associations, and long-term outcome. Arthritis Rheum 2004; 50(8) Daugas E, Nochy D, Huong DL, Duhaut P, Beaufils H, Caudwell V, et al. Antiphospholipid syndrome nephropathy in systemic lupus erythematosus. J Am Soc Nephrol 2002; 13(1) Olguin L, Calleja C, Hernandez C, Roosi Y, Murison M. Primary antiphospholipid syndrome nephropathy despite anticoagulant therapy. Artritis Rheum 2003; 48(2) Miranda JM, Garcia-Torres R, Jara LJ, Medina F, Cervera H, Fraga A. Renal biopsy in systemic lupus erythematosus significance of glomerular thrombosis. Analysis of 108 cases. Lupus 1994; 3(1) Ruiz-Irastorza G, Egurbide MV, Ugalde J, Aguirre C. High impact of antiphospholipid syndrome on irreversible organ damage and survival of patients with systemic lupus erythematosus. Arch Intern Med 2004; 164(1) Amigo MC. Kidney disease in antiphospholipid syndrome. Rheum Dis Clin North Am 2006; 32(3) Joseph RE, Radhakrishnan J, Appel GB. Antiphospholipid antibody syndrome and renal disease. Curr Opin Nephrol Hypertens 2001; 10(2) Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002; 346(10) Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002; 46(4) Churg J. Renal Disease Classification and Atlas of Glomerular Diseases. New York Igaku-Shoin Medical Pub; Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004; 15(2)

8 Original Article Received Accepted Journal of Isfahan Medical School Vol 26, No 89, Summer 2008 Anti phospholipid Syndrome Nephropathy in Patients with Lupus Nephritis Ali Sadoogh Abbasian MD*, Zahra Seyed Bonakdar MD**, Diana Taheri MD***. Background Methods Findings Conclusion Key words Page count Tables Figures References Address of Correspondence * Resident of internal Medicine, Isfahan university of Medical Sciences, Isfahan, Iran. ** Assistant Professor, Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran. *** Assistant Professor, Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran. Abstract Increasing the Antiphospholipid-nephropathy (-N) alterations on lupus renal lesions cause renal disease progression and detoriation of prognosis. The aim of this study was to find some indicators in lupus patients that can predict the occurring of -N in them and can be construct the preventive treatments for prevention of more complications. In this descriptive study, the renal biopsy specimens of 66 patients with lupus nephritis, were reviewed according to new classification of lupus nephritis ISN/RPS 2003 by a nephropathologist and synchronous alterations due to, were studied. Results were analyzed by SPSS-12 and statistical methods, independent sample test, chi-square. The -N alterations were seen in 31.8% of patients. The most common class of lupus nephritis was IV. There was no significant difference between any one of the lupus nephritis class and the existence of synchronous -N alterations (P > 0.05), between lupus nephritis and -N with serum Cr level at the time of renal biopsy (P = 0.434) and also between the presence of anti phospholipid antibodies and the existence of synchronous -N alterations (P = 0.904). The difference between clinical signs (thrombosis, ischemia) and existence of the synchronous -N alterations, was strongly significant (P = 0.001). This study recommend that pathologists should be careful to diagnose and report the existence of synchronous -N alterations in renal biopsy specimens related to lupus nephritis patients, because these alterations help the physician to carry out proper treatment and prevent of future vascular thrombotic events in lupus nephritis patients. Anti phospholipid syndrome, lupus nephritis, normal pathology Sadoogh abbassian Ali,MD. Resident of internal Medicine, Isfahan university of Medical Sciences, Isfahan, Iran. alisadoogh@yahoo.com Q