Abstract: SA-PO0800
Complex Lupus Nephritis with Antiphospholipid Syndrome and Recurrent Arteriovenous (AV) Fistula Thrombosis
Session Information
- Glomerular Diseases: Lupus Nephritis, Monoclonal Gammopathy-Related Disease, and Transplantation
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Kanu, Donald Orji, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Mirza, Sabbir, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Isidor, Marc H., HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Khan, Rahil, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
- Razuman, Samerah Guro, HCA Florida Lawnwood Hospital, Fort Pierce, Florida, United States
Group or Team Name
- Team Lawnwood
Introduction
SLE-associated lupus nephritis (LN) affects up to 50% of patients and is a leading cause of ESRD. Co-existing antiphospholipid syndrome (APS) amplifies thrombotic risk, complicating vascular access in hemodialysis-dependent patients. We present a uniquely complex case of a young woman with SLE-related ESRD, two failed renal transplants, and APS-driven recurrent AV fistula thrombosis,
Case Description
A 33-year-old female with SLE, LN, ESRD (post two transplants, 2016 and 2021), and APS presented with acute left AV fistula thrombosis — confirmed by loss of bruit and thrill — while on apixaban. Labs: creatinine 12.00 mg/dL, eGFR 4 mL/min/1.73, BUN 56 mg/dL, AST/ALT 153/181 U/L, troponin I 32.9 ng/L, mild anemia, and leukopenia. Chest X-ray was negative. Management: vascular surgery consultation, anticoagulation transition to warfarin, dialysis bridging, and nephrology evaluation for third transplant candidacy. SLE therapy continued with prednisone; addition of mycophenolate or belimumab was discussed.
Discussion
This case is exceptional: SLE/LN progressing to ESRD despite two allografts, APS driving recurrent fistula thrombosis on anticoagulation, subclinical cardiac involvement, and hepatotoxicity — converging in a 33-year-old. SLE-mediated endothelial activation lowers the threshold for APS-mediated thrombosis, rendering apixaban — not validated for thrombotic APS — insufficient. The patient was stabilized with vascular intervention and coordinated multidisciplinary discharge planning.
Teaching Points
APS independently drives AV fistula failure — anticoagulation must be individualized and monitored rigorously.
DOACs are not recommended for thrombotic APS; warfarin with INR 2.5–3.5 remains the standard of care.
Post-transplant recurrent LN needs re-evaluation of immunosuppressive adequacy and consideration of novel biologics.
Troponin elevation in SLE/APS patients warrants cardiac evaluation for Libman-Sacks endocarditis, myocarditis, or ischemia.
Table 1. Key laboratory and imaging findings at presentation.
| Parameter | Value | Clinical Significance |
| Creatinine | 12.00 mg/dL | ESRD; severely reduced renal function |
| BUN | 56 mg/dL | Elevated; consistent with Uremic state |
| eGFR | 4 mL/min/1.73 m^3 | Stage G5 CKD |
| AST/ALT | 153/181 U/L | Hepatic involvement or drug-induced injury |
| Troponin I | 32.9 ng/L | Mildly elevated; warrants cardiology evaluation |
| CBC | Anemia, Leukopenia | Chronic disease; immunosuppresion effect |
| Chest X-ray | No acute disease | No acute cardiopulmonary process |