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Abstract Antiphospholipid syndrome is a rare, but potentially devastating condition. Patients with APS develop significant morbidity and mortality despite current therapy. Renal disease is present in 8 to 10% of patients with APS. In addition to APS nephropathy, glomerular diseases, in particular membranous nephropathy (MN) can occur. Kidney biopsy can have an important role in the treatment of these patients. The heterogeneity of renal involvement confirms the presence of a continuum between SLE and PAPS. Renal prognosis seems to be good. Not all of the clinical manifestations of PAPS can be interpreted on the basis on thrombotic lesions. Our findings confirm that PAPS can be considered an autoimmune systemic disease. Anticoagulation remains the mainstay treatment of patients with renal involvement due to APS. In addition, patients with catastrophic features often require immunosuppressive therapy. Repeated positivity for LA and⁄ or solid-phase antibodies is considered a risk factor for clinical events; however, no precise information on the relative risk conferred by single or combined positivity is available. Recent investigations addressing this issue found that multiple positivity in tests exploring the presence of aPA ismore frequently associated with thrombo embolic events and pregnancy morbidity than single-test positivity. One important aspect of the APS is that patients should be stratified and treated according to some clinical and immunologic characteristics in addition to the aPA positivity. In this sense, closer control of vascular risk factors and therapeutic monitoring (to ensure a correct INR) are important clues in the management of patients with APS and thrombosis in order to improve their morbidity and mortality rates. |