Prognostic importance of vascular lesions in acute renal failure with microangiopathic hemolytic anemia (hemolytic-uremic syndrome): Clinicopathologic study in 20 adults

Abstract

Renal biopsies obtained from 20 adult patients within 30 days after onset of acute renal failure with microangiopathic hemolytic anemia ("the hemolytic-uremic syndrome") were studied. Lesions were graded independently by two observers without knowledge of the clinical history. All patients who did not have refractory hypertension were treated with heparin. Ten of the patients died, and four developed end-stage renal failure requiring chronic dialysis. Six patients, however, had a relatively good outcome: two recovered completely and four developed mild-to-moderate chronic renal failure not requiring dialysis. The six patients with a good outcome had significantly less severe arterial intimal thickening on biopsy compared with the remaining patients with a poor outcome. The patients with a good outcome and those with a poor outcome did not differ in the severity of glomerular lesions. The clinical features did not allow a prediction of late outcome. These results suggest that early renal biopsies may be helpful in predicting prognosis in the "hemolytic-uremic syndrome." This clinical syndrome may occur either in apparently healthy people, or may complicate the course of a chronic essential hypertension.

Renal Thrombotic Microangiopathies Induced by Severe Hypertension

“…This may partly explain the low prevalence of microangiopathic hemolytic anemia in these patients. Morel-Maroger et al (15) disclosed that microangiopathic hemolytic anemia may occur in apparently healthy people, or may complicate the course of chronic essential hypertension. The patients with a good outcome and those with a poor outcome did not differ in the severity of glomerular lesions but did differ in the severity of arterial intimal thickening.…”

Glomerular Ultrastructural Lesions of Idiopathic Cutaneous and Renal Glomerular Vasculopathy of Greyhounds

“…12,28,31 Distinguishing between these patterns of involvement has some prognostic value. 24 The ultrastructural lesions in Greyhounds with CRGV also most closely resemble those of the childhood variant of HUS.9JoJ6,33,3s In Greyhounds with CRGV and children with HUS, lesions are predominately glomerular and include marked reduction of the capillary lumina due to expansion of the subendothelia1 space by flocculent material; occlusion of the cap-illaries by aggregates of platelets, erythrocytes, fibrin, and cellular fragments; endothelial swelling, hypertrophy, and villous cytoplasmic projections; and interposition of mesangial cytoplasmic processes within the subendothelial space.…”

Microangiopatias trombóticas: púrpura trombocitopênica trombótica e síndrome hemolítico-urêmica

“…13,[68][69][70] However, the effectiveness of the use of plasma in the treatment of acute episodes is still controversial. 71 Some studies have shown that a consistent percentage of patients with atypical HUS respond to treatment with plasma.…”