Secondary thrombotic microangiopathy


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Thrombotic microangiopathy (TMA) is a clinico-morphological syndrome belonging to the spectrum of diseases with endothelial damage as an etiological factor. The article discusses issues of classification, features and pathogenesis of secondary TMA, strategies for modern diagnostics and treatment. The clinical picture of secondary TMA has no specific features. The criteria for making a clinical diagnosis of TMA include the presence of at least two symptoms: thrombocytopenia and microangiopathic hemolytic anemia. The development of secondary TMA is associated with a wide range of different diseases and conditions discussed in this review. Their timely detection is the most important, because it greatly improves the prognosis. Timely diagnosis and treatment of TMA associated with pregnancy demonstrate good results. On the other hand, the prognosis for TMA associated with hematopoietic stem cell transplantation and for TMA associated with chemotherapy remains unfavorable. Currently there are no generally accepted standards for the treatment of secondary TMA.

Full Text

Restricted Access

About the authors

A. M Esayan

Pavlov First St. Petersburg State Medical University; Department of Nephrology and Dialysis

Email: essaian.ashot@gmail.com
Professor, Head of the Department of Nephrology and Dialysis FPGE

A. R Rind

Pavlov First St. Petersburg State Medical University; Department of Nephrology and Dialysis

Resident Physician at the Department of Nephrology and Dialysis FPGE

References

  1. Клинические рекомендации по нефрологии. Под ред. Е.М. Шилова. C. 320-325
  2. Coppo P. Secondary thrombotic microangiopathies. Rev. Med. Interne. 2017;38(11):731-36. Doi:https://doi.org/10.1016/j.revmed.2017.06.025
  3. Scully M. Cancer and trombotic microangiopathy. Journal of oncology practice. 2G16;12(16):531-532
  4. ХБП у ВИЧ-ассоциированных пациентов: национальные клинические рекомендации. Под ред. Т.В. Волгина, 2015
  5. Becker S. HIV-associated thrombotic microangiopathy in the era of highly active antiretroviral therapy: an observational study. Clin. Infect. Dis. 2004;1(5):267-275. Doi: https://doi.org/10.1086/422363
  6. Rodriguez-Pinto I. CAPS Registry Project Group (European Forum on Antiphospholipid Antibodies): Catastrophic antiphospholipid syndrome (CAPS): Descriptive analysis of 500 patients from the international CAPS registry. Autoimmun. Rev. 2016;15:1120-1124. Doi: https://doi.org/10.1016/j. autrev.2016.09.010
  7. Brocklebank V.K.D. Complement C5 inhibiting therapy for the thrombotic microangiopathies: Accumulating evidence, but not a panacea. Clin. Kidney J. 2017. Doi: https://doi.org/10.1093/ckj/sfx081
  8. Pattanashetti Effect of Thrombotic Microangiopathy on Clinical Outcomes in Indian Patients With Lupus Nephritis N. Kidney Int. Rep. Doi: https://doi. org/10.1016/j.ekir.2017.04.008.
  9. Yu F., Tan Y., Zhao M.H. Lupus nephritis combined with renal injury due to thrombotic thrombocytopaenic purpura-haemolytic uraemic syndrome. Nephrol. Dial. Transplant. 2010;25(1):145-152. Doi: https://doi.org/10.1093/ ndt/gfp421.
  10. Jodele S., Dandoy C.E., Myers K.C., El-Bietar J., Nelson A., Wallace G., Laskin B.L. New approaches in the diagnosis, pathophysiology, and treatment of pediatric hematopoietic stem cell transplantation-associated thrombotic microangiopathy. Transfus. Apher. Sci. 2016;54:181-190. Doi: https://doi. org/10.1016/j.transci.2016.04.007.
  11. Chapin J., Shore T., Forsberg P., Desman G., Van Besien K., Laurence J. Hematopoietic transplant-associated thrombotic microangiopathy: Case report and review of diagnosis and treatments. Clin. Adv. Hematol. Oncol. 2014;12: 565-573.
  12. Dhakal P., Bhatt V.R. Is complement blockade an acceptable therapeutic strategy for hematopoietic cell transplant-associated thrombotic microangiopathy? Bone Marrow Transplant. 2017;52:352-356. Doi: https://doi.org/10.1038/ bmt.2016.253.
  13. Байбарина А.М. ТМА в акушерстве. 2018 г.
  14. Баранов А.А. Метилмалоновая ацидурия у детей: клинические рекомендации. 2017.
  15. Fakhouri F., et al. Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J. Am. Soc. Nephrol. 2010;21:859- 867. Doi: https://doi.org/10.1681/ASN.2009070706.
  16. Hovinga J.A., et al. Survival and relapse in patients with thrombotic thrombocytopenic purpura. Blood. 2010;115:1500-1511. Doi: https://doi. org/10.1182/blood-2009-09-243790.
  17. Veyradier A., et al. Specific von Willebrand factor-cleaving protease in thrombotic microangiopathies: a study of 111 cases. Blood. 2001;98:1765- 1772.
  18. Vesely S.K., et al. ADAMTS13 activity in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: Relation to presenting features and clinical outcomes in a prospective cohort of 142 patients. Blood. 2003;102:60- 68. Doi: https://doi.org/10.1182/blood-2003-01-0193
  19. Waiser J., Budde K., Rudolph B., Ortner M.A., Neumayer H.H. De novo hemolytic uremic syndrome postrenal transplant after cytomegalovirus infection. Am. J. Kidney Dis. 1999;34:556-559. Doi: https://doi.org/10.1053/ AJKD03400556.
  20. Murer L., Zacchello G., Bianchi D., DallAmico R., Montini G., Andreetta B., et al. Thrombotic microangiopathy associated with parvovirus B19 infection after renal transplantation. J. Am. Soc. Nephrol. 2000;11:1132-1137.
  21. Asaka M., Ishikawa I., Nakazawa T., Tomosugi N., Yuri T., Suzuki K. Hemolytic uremic syndrome associated with influenza A virus infection in an adult renal allograft recipient: case report and review of the literature. Nephron. 2000;84:258-266. Doi: https://doi.org/10.1159/000045586.
  22. Schwimmer J., Nadasdy T.A., Spitalnik P.F., Kaplan K.L., Zand M.S. De novo thrombotic microangiopathy in renal transplant recipients: a comparison of hemolytic uremic syndrome with localized renal thrombotic microangiopathy. Am. J. Kidney Dis. 2003;41:471-479. Doi: https://doi.org/10.1053/ajkd.2003.50058.
  23. Magro C.M., Momtahen S., Mulvey J.J., Yassin A.H., Kaplan R.B., Laurence J.C. Role of the skin biopsy in the diagnosis of atypical hemolytic uremic syndrome. Am. J. Dermatopathol. 2015;37:349-359. Doi: https://doi. org/101097/DAD.0000000000000234.
  24. Артериальная гипертония у взрослых: клинические рекомендации. Под ред. Е.И. Чазова. 2016.
  25. Guzik T. Malignant hypertension: new aspects of an old clinical entity. Pol. Arch. Med. Wewn. 2016;126(1-2):86-93.
  26. Shantsila А., Lip G.Y.H. Malignant Hypertension Revisited-Does This Still Exist? Am. Journ. of Hypertension. 2017;1;30(6):543-549. Doi: https://doi. org/10.1093/ajh/hpx008.
  27. Mathew R.O., et al. The endothelium as the common denominator in malignant hypertension and thrombotic microangiopathy. JASH. 2015;12:352. Doi: https://doi.org/10.1016/j.jash.2015.12.007.
  28. Bert-Jan H., van den Born, et al. Association between thrombotic microangiopathy and reduced ADAMTS13 activity in malignant hypertension. Hypertension. 2008;51:862-866. Doi: https://doi.org/10.1161/ HYPERTENSIONAHA.107.103127.
  29. Lechner K., Obermeier H.L. Cancer-related microangiopathic hemolytic anemia: clinical and laboratory features Medicine (Baltimore). 2017;91(4):195-205. Doi: https://doi.org/10.1097/MD.0b013e3182603598.
  30. Moake J.L. Thrombotic microangiopathies. N. Eng. J. Med. 2002;347:589- 600.
  31. Moake J.L. Thrombotic thrombocytopenic purpura: the systemic clumping «plague». Ann. Rev. Med. 2002;53:75-88. Doi: https://doi.org/10.1146/ annurev.med.53.082901.103948.
  32. Allford S.L., Hunt B.J., Rose P., Machin S. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br. J. Haematol. 2003;120:556-573.
  33. Su-Fang Chen, et al. Clinicopathologic Characteristics and Outcomes of Renal Thrombotic Microangiopathy in Anti-Neutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis. Clin. J. Am. Soc. Nephrol. 2015;10(5):750- 758. Doi: https://doi.org/10.2215/CJN.07910814.
  34. Buob D. Collapsing glomerulopathy is common in the setting of thrombotic microangiopathy of the native kidney. Kidney Int. 2016;90(6):1321-1331. Doi: https://doi.org/10.1016/j.kint.2016.07.021.
  35. Gopalakrishnan N., et al. Collapsing glomerulopathy and thrombotic microangiopathy in postpartum period: two case reports. Indian J. Nephrol. 2018;28(2):157-159. Doi: https://doi.org/10.4103/ijn.IJN_242_16.
  36. El Karoui K., Hill G.S., Karras A., et al. A dinicopathologic study of thrombotic microangiopathy in IgA nephropathy. J. Am. Soc. Nephrol. 2012; 23(1):137- 148. Doi: https://doi.org/10.1681/ASN.2010111130.
  37. Bommer M., Wolfle-Guter M., Bohl S., Kuchenbauer F. The Differential Diagnosis and Treatment of Thrombotic Microangiopathies. Dtsch. Arztebl. Int. 2018;115(19):327-334. Doi: https://doi.org/10.3238/arztebl.2018.0327.
  38. Van den Born B.J., van der Hoeven N.V., Groot E., Lenting P.J., Meijers J.C., Levi M., et al. Association between thrombotic microangiopathy and reduced ADAMTS13 activity in malignant hypertension. Hypertension. 2008;51:862- 866. Doi: https://doi.org/10.1161/HYPERTENSIONAHA.107.103127.
  39. Kello N., Khoury L.E. Secondary thrombotic microangiopathy in systemic lupus erythematosus and antiphospholipid syndrome, the role of complement and use of eculizumab: case series and review of literature. Semin. Arthr. Rheum. 2018;4.
  40. Kishida N. Increased Incidence of Thrombotic Microangiopathy After ABO-Incompatible Living Donor Liver Transplantation. Ann. Transplant. 2016;13(21):755-764.
  41. Verbiest A. De novo thrombotic microangiopathy after non-renal solid organ transplantation. Blood Rev. 2014;28(6):269-279. Doi: https://doi. org/10.1016/j.blre.2014.09.001.
  42. Zhang J.A. Сase of malignant hypertension with thrombotic microangiopathy. Intern. Med J. 2018;48(3):361-362. Doi: https://doi.org/10.1111/imj.13724.
  43. Timmermans S., et al. Limburg Renal Registry: Patients with hypertension-associated thrombotic microangiopathy may present with complement abnormalities. Kidney Int. 2017;91:1420-1425. Doi: https://doi.org/10.1016//. kint.2016.12.009.
  44. Van Laecke S. Severe hypertension with renal thrombotic microangiopathy: What happened to the usual suspect? Kidney Int. 2017;91:1271-1274. Doi: https://doi.org/10.1016/j.kint.2017.02.025.
  45. Ozaltin F. DGKE variants cause a glomerular microangiopathy that mimics membranoproliferative GN. J. Am. Soc. Nephrol. 2013;24:377-384. Doi: https://doi.org/10.1681/ASN.2012090903.
  46. Zayd L. Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood. 2015;125:616-618. Doi: https://doi.org/10.1182/ blood-2014-11-611335.
  47. George J.N. Syndromes of thrombotic microangiopathy. N. Engl. J. Med. 2014;371(7):654-666. doi: 10.1056/NEJMra1312353.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies