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Chronic APSN Progressive Nephrosclerosis — ESENeph MCQ

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HardHypertensionChronic APSN Progressive NephrosclerosisESENeph

A patient with antiphospholipid syndrome on therapeutic warfarin has slowly progressive CKD. Biopsy shows chronic fibrous intimal hyperplasia and organized thrombotic microangiopathy without active inflammation. What does this represent?

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Correct answer: A — Chronic antiphospholipid nephropathy with vaso-occlusive cortical ischaemia

The best answer is “Chronic antiphospholipid nephropathy with vaso-occlusive cortical ischaemia”. Organized thrombi and fibrous intimal change represent accumulated APS microvascular injury. Anticoagulation, blood-pressure control and proteinuria management prevent further injury but do not reverse established fibrosis. “Active lupus nephritis with immune-complex glomerular inflammation” is less appropriate because the biopsy shows chronic thrombotic vascular injury rather than immune-complex nephritis “Warfarin-related nephropathy with glomerular haemorrhage and tubular obstruction” is less appropriate because warfarin is protective against APS thrombosis and is not the described cause “Cholesterol embolism with arteriolar clefts and eosinophilia” is less appropriate because cholesterol clefts and a compatible embolic trigger would be expected “Fibromuscular dysplasia with renovascular hypertension and arterial beading” is less appropriate because this does not produce the characteristic intrarenal chronic TMA pattern

Reference: EULAR recommendations for antiphospholipid syndrome: https://ard.bmj.com/content/78/10/1296