Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study

Objective: Thrombotic microangiopathy (TMA) is often first detected on a renal biopsy performed for renal manifestations. Apart from hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura, there are various secondary conditions associated with TMA. This study analyzes the clinico-pa...

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Main Authors: Niraimathi MANICKAM, Vinita AGRAWAL, Pallavi PRASAD, Manoj JAIN, Narayan PRASAD
Format: Article
Language:English
Published: Federation of Turkish Pathology Societies 2022-01-01
Series:Türk Patoloji Dergisi
Subjects:
Online Access: http://www.turkjpath.org/pdf.php3?id=1974
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author Niraimathi MANICKAM
Vinita AGRAWAL
Pallavi PRASAD
Manoj JAIN
Narayan PRASAD
author_facet Niraimathi MANICKAM
Vinita AGRAWAL
Pallavi PRASAD
Manoj JAIN
Narayan PRASAD
author_sort Niraimathi MANICKAM
collection DOAJ
description Objective: Thrombotic microangiopathy (TMA) is often first detected on a renal biopsy performed for renal manifestations. Apart from hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura, there are various secondary conditions associated with TMA. This study analyzes the clinico-pathological spectrum, etiological factors and renal outcome of TMA diagnosed on renal biopsy. Material and Method: A retrospective evaluation of renal biopsies for TMA over 5.5 years was performed. Clinical and laboratory data was collected from patient records. Results: A total of 40 biopsies from 39 patients showed TMA comprising 33 native and 7 transplant biopsies. Malignant hypertension (n=13) was the most common etiology in native biopsies followed by postpartum TMA (n=7), atypical HUS (aHUS) (n=7), and lupus nephritis (n=6). TMA in transplant biopsies was due to acute rejection (n=4) and CNI toxicity (n=3). Serum creatinine was high in most patients (mean 5.6 + 2.5 mg/ dl). aHUS showed the highest mean LDH levels and the lowest average platelet counts. Renal biopsies in malignant hypertension and postpartum TMA showed isolated arterial changes while aHUS and lupus nephritis showed both glomerular and arterial involvement. Postpartum TMA and aHUS had poor renal outcome requiring renal replacement therapy. Conclusion: Most postpartum TMA and aHUS had systemic features of TMA while malignant hypertension and lupus nephritis showed 'isolated renal TMA'. This emphasizes the importance of careful evaluation of renal biopsies even in the absence of systemic features of TMA.
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spelling doaj.art-d308d68acb6744ea8e66ca7af099e7f62023-02-15T16:21:29ZengFederation of Turkish Pathology SocietiesTürk Patoloji Dergisi1018-56151309-57302022-01-0138100100810.5146/tjpath.2021.01536Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective StudyNiraimathi MANICKAMVinita AGRAWALPallavi PRASADManoj JAINNarayan PRASADObjective: Thrombotic microangiopathy (TMA) is often first detected on a renal biopsy performed for renal manifestations. Apart from hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura, there are various secondary conditions associated with TMA. This study analyzes the clinico-pathological spectrum, etiological factors and renal outcome of TMA diagnosed on renal biopsy. Material and Method: A retrospective evaluation of renal biopsies for TMA over 5.5 years was performed. Clinical and laboratory data was collected from patient records. Results: A total of 40 biopsies from 39 patients showed TMA comprising 33 native and 7 transplant biopsies. Malignant hypertension (n=13) was the most common etiology in native biopsies followed by postpartum TMA (n=7), atypical HUS (aHUS) (n=7), and lupus nephritis (n=6). TMA in transplant biopsies was due to acute rejection (n=4) and CNI toxicity (n=3). Serum creatinine was high in most patients (mean 5.6 + 2.5 mg/ dl). aHUS showed the highest mean LDH levels and the lowest average platelet counts. Renal biopsies in malignant hypertension and postpartum TMA showed isolated arterial changes while aHUS and lupus nephritis showed both glomerular and arterial involvement. Postpartum TMA and aHUS had poor renal outcome requiring renal replacement therapy. Conclusion: Most postpartum TMA and aHUS had systemic features of TMA while malignant hypertension and lupus nephritis showed 'isolated renal TMA'. This emphasizes the importance of careful evaluation of renal biopsies even in the absence of systemic features of TMA. http://www.turkjpath.org/pdf.php3?id=1974 thrombotic microangiopathymalignant hypertensionhemolytic uremic syndrome lupus nephritis
spellingShingle Niraimathi MANICKAM
Vinita AGRAWAL
Pallavi PRASAD
Manoj JAIN
Narayan PRASAD
Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study
Türk Patoloji Dergisi
thrombotic microangiopathy
malignant hypertension
hemolytic uremic syndrome
lupus nephritis
title Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study
title_full Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study
title_fullStr Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study
title_full_unstemmed Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study
title_short Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study
title_sort clinico histological features of thrombotic microangiopathy in renal biopsies a retrospective study
topic thrombotic microangiopathy
malignant hypertension
hemolytic uremic syndrome
lupus nephritis
url http://www.turkjpath.org/pdf.php3?id=1974
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AT vinitaagrawal clinicohistologicalfeaturesofthromboticmicroangiopathyinrenalbiopsiesaretrospectivestudy
AT pallaviprasad clinicohistologicalfeaturesofthromboticmicroangiopathyinrenalbiopsiesaretrospectivestudy
AT manojjain clinicohistologicalfeaturesofthromboticmicroangiopathyinrenalbiopsiesaretrospectivestudy
AT narayanprasad clinicohistologicalfeaturesofthromboticmicroangiopathyinrenalbiopsiesaretrospectivestudy