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Case report
Chronic thrombotic microangiopathy secondary to antiphospholipid syndrome, presenting with severe hypertension and chronic renal impairment
  1. Yucai Yee1,
  2. Stanley Angkodjojo2,3 and
  3. Puay Hoon Tan4
  1. 1 Department of Internal Medicine, Singapore General Hospital, Singapore
  2. 2 Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore
  3. 3 Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
  4. 4 Division of Pathology, Singapore General Hospital, Singapore
  1. Correspondence to Dr Yucai Yee, yee.yucai{at}


A 42-year-old woman was referred from a primary care centre for severe hypertension, stage 3A chronic kidney disease and proteinuria. This was associated with a significant obstetric history of pre-eclampsia during her previous two pregnancies. Secondary hypertension was suspected and autoimmune workup was positive for anticardiolipin IgG and lupus anticoagulant. A renal biopsy showed evidence of chronic thrombotic microangiopathy, with electron microscopy features suggestive of fibrillar glomerulonephritis. The diagnosis of antiphospholipid syndrome with antiphospholipid-associated nephropathy was made. She was started on anticoagulation with warfarin, and her hypertension was controlled with lisinopril and amlodipine with subsequent improvement in proteinuria. She remains on regular follow-up to monitor for possible development of malignancy or connective tissue disease.

  • chronic renal failure
  • connective tissue disease
  • general practice / family medicine

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  • Contributors YY drafted the manuscript. SA and PHT proofread and edited the manuscript. PHT reported the renal biopsy and provided selected histopathology slides with captions. All authors were involved in the care of the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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