Thrombotic Microangiopathy Syndromes—Common Ground and Distinct Frontiers

Hanna, Ramy M; Henriksen, Kammi J.; Kalantar‐Zadeh, Kamyar; Ferrey, Antoney; Burwick, Richard M.; Jhaveri, Kenar D.

doi:10.1053/j.ackd.2021.11.006

Cited by 13 publications

(14 citation statements)

References 116 publications

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“…Withdrawal of the offending drug and transition to a t-cell co-stimulatory blocker (e.g. belatacept or abatacept) may be an effective alternate immunosuppressive strategy [52].…”

Section: Acute Adverse Effects Of Immunosuppressive Therapymentioning

confidence: 99%

Management of the kidney transplant recipient in the intensive care unit

Voora,

Shah,

Nadim

2023

Current Opinion in Critical Care

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Purpose of review Kidney transplantation is the ideal treatment for patients with chronic kidney disease and end stage renal disease. While centers are performing more transplants every year, the need for organ transplantation outpaces the supply of organ donors Due to a growing population of patients with advanced kidney disease and a scarcity of kidneys from deceased donors, patients face extended wait times. By the time patients approach transplantation they have multiple comorbidities, in particular cardiovascular complications. Their risk of complications is further compounded by exposure to immunosuppression post kidney transplantation. Kidney transplant recipients (KTRs) are medically complex and may require acute management in the intensive care unit (ICU), as a result of cardiovascular complications, infections, and/or respiratory compromise from lung infections and/or acute pulmonary edema. Acute complication of immunosuppression, such as thrombotic microangiopathy and posterior reversible encephalopathy syndrome may also warrant ICU admission. This review will cover assessment of high-risk complications and management strategies following kidney transplantation. Recent findings For intensivists caring for KTRs, it is imperative to understand anatomical considerations of the transplanted kidney, unique infectious risks faced by this population, and appropriate modulation of immunosuppression. Summary Recognizing potential complications and implementing appropriate management strategies for KTRs admitted to the ICU will improve kidney allograft and patient survival outcomes.

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“…Withdrawal of the offending drug and transition to a t-cell co-stimulatory blocker (e.g. belatacept or abatacept) may be an effective alternate immunosuppressive strategy [52].…”

Section: Acute Adverse Effects Of Immunosuppressive Therapymentioning

confidence: 99%

Management of the kidney transplant recipient in the intensive care unit

Voora,

Shah,

Nadim

2023

Current Opinion in Critical Care

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“…Various TA-TMA diagnostic criteria have been published [16], but use of the modified Jodele criteria is recommended – see Table 2 (a & b) [17 ▪ ]. In TA-TMA, a three-hit model is postulated: activation of endothelium to a procoagulant state (first hit) followed by activation of antigen presenting cells, lymphocytes, and downstream immunologic and inflammatory activation (second hit); and finally, activation of complement with ensuing endothelial activation and damage [16,17 ▪ ,18,19 ▪▪ ]. Excessive terminal complement activation can be measured using soluble C5b-9 levels (also known as ‘soluble MAC’) [17 ▪ ].…”

Section: Thrombotic Microangiopathies: Multiple Causes and Disease Mi...mentioning

confidence: 99%

“…Other causes of TMA include hypertensive emergency, scleroderma renal crisis, disseminated intravascular coagulation (DIC), shiga-toxin mediated TMA (i.e., classical HUS), and thrombotic thrombocytopenic purpura (TTP) [19 ▪▪ ,33 ▪ ,34]. In TTP, deficiency of a d isintegrin a nd m etalloprotease with a t hrombospondin type 1 motif, member 13 (ADAMTS-13) causes accumulation of ultra large molecular weight multimers of von Willebrand Factor (VWF), systemic microvascular thrombosis, consumptive thrombocytopenia, MAHA, and end organ involvement.…”

Section: Thrombotic Microangiopathies: Multiple Causes and Disease Mi...mentioning

confidence: 99%

Thrombotic microangiopathy – the importance of a multidisciplinary approach

Tran,

Patel,

Desai

et al. 2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review The purpose of this review is to highlight the importance of a multidisciplinary thrombotic microangiopathies (TMA) Team. This goal will be accomplished through review of the complement system, discuss various causes of thrombotic microangiopathies (TMA), and aspects of their diagnosis and management. In so doing, readers will gain an appreciation for the complexity of this family of disorders and realize the benefit of a dedicated multidisciplinary TMA Team. Recent findings TMA causes derive from multiple specialty areas, are difficult to timely recognize, pose complex challenges, and require multidisciplinary management. Hematopoietic stem cell transplant-associated TMA (TA-TMA) and TA-TMA related multiorgan dysfunction syndrome (TA-TMA MODS) are areas of burgeoning research; use of complement testing and eculizumab precision-dosing has been found to better suppress complement activity in TA-TMA than standard eculizumab dosing. Newer tests are available to risk-stratify obstetric patients at risk for severe pre-eclampsia, whose features resemble those of TA-TMA MODS. Numerous disorders may produce TMA-like findings, and a systematic approach aids in their identification. TMA Teams elevate institutional awareness of increasingly recognized TMAs, will help expedite diagnostic and therapeutic interventions, and create pathways to future TMA-related research and facilitate access to clinical trials. Summary Establishment of a TMA-Team is valuable in developing the necessary institutional expertise needed to promptly recognize and appropriately manage patients with TMA.

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“…Среди аутоиммунных заболеваний основной причиной ТМА является антифосфолипидный синдром (АФС) [26]. Наиболее тяжелый вариант этого состояния -катастрофический АФС, который характеризуется поражением не только почек, но и других органов с развитием полиорганной недостаточности.…”

Section: тромботическая микроангиопатияunclassified

Autoimmunity, autoinflammation and kidney

Moiseev¹,

Bulanov²

2022

CPT

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Systemic autoimmune and autoinflammatory disease are associated with all types of diffuse kidney disease, that is, glomerulonephritis (including rapidly progressive), thrombotic microangiopathy, tubulointerstitial nephritis, and AA-amyloidosis. However, the occurrence and types of nephropathies differ significantly in patients with various systemic immunemediated inflammatory diseases. For example, glomerulonephritis is one of the leading manifestation of systemic lupus erythematosus and small-vessels vasculitis, thrombotic angiopathy occurs frequently in patients with both primary and secondary antiphosholipid syndrome, tubulointerstitial nephritis is frequently found in patients with Sjogren syndrome and IgG4-associated disease, whereas AA-amyloidosis can complicate rheumatoid arthritis, ankylosing spondilytis, psoriatic arthritis, familial Meditarranean fever, and certain other monogenic autoinflammatory diseases. Over last decades, renal survival in patients with autoimmune and autoinflammatory diseases improved significantly due to earlier diagnosis and development of effective immunosuppressive and anti-inflammatory treatments. However, a proportion of patients still present with progressive impairment of kidney function that can be unrelated to activity of underlying diseases.

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Thrombotic Microangiopathy Syndromes—Common Ground and Distinct Frontiers

Cited by 13 publications

References 116 publications

Management of the kidney transplant recipient in the intensive care unit

Management of the kidney transplant recipient in the intensive care unit

Thrombotic microangiopathy – the importance of a multidisciplinary approach

Autoimmunity, autoinflammation and kidney

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