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ISSN 1527-3172 (Electronic)

2022, Number 1

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MEDICC Review 2022; 24 (1)

Thrombotic microangiopathy in patients recovering from COVID-19

López-Marín L, Bacallao-Méndez RA, Llerena-Ferrer B, Badell-Moore A, García-Villar Y, Rodríguez-Leyva L, Herrera-Valdés R

Language: English
References: 15
Page: 32-35
PDF size: 241.71 Kb.


ABSTRACT

INTRODUCTION During the pandemic caused by the SARS-CoV-2 virus, some patients who develop severe forms of COVID-19 present thrombotic microangiopathy in the course of the disease’s clinical progression.
METHODS Data came from direct patient observation and clinical records. We performed a kidney biopsy and used optical microscopy and immunofluorescence techniques.
RESULTS We present the case of a 78-year-old male patient, mestizo, overweight with a history of high blood pressure, ischemic cardiopathy and chronic obstructive pulmonary disease who was first admitted to the hospital due to respiratory symptoms and diarrhea related to COVID-19, from which he recovered. He was subsequently readmitted with symptoms of acute renal dysfunction accompanied by mild anemia and thrombocytopenia; at the same time, he resulted negative for COVID-19 via a real-time polymerase chain reaction test. A kidney biopsy revealed thrombi in glomerular capillaries, acute tubular necrosis, thickening of extraglomerular blood vessel walls, and C3 deposits in the glomerular tufts.
CONCLUSIONS We describe a case of thrombotic microangiopathy with kidney biopsy in a patient recovering from COVID-19. Acute renal dysfunction is a form of thrombotic microangiopathy that has been observed in patients recovering from COVID-19.


REFERENCES

  1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, etal. Clinical features of patients infected with 2019novel coronavirus in Wuhan, China. Lancet. 2020Feb 15;395(10223):497–506.

  2. Iba T, Levy JH, Connors JM, Warkentin TE,Thachil J, Levi M. The unique characteristics ofCOVID-19 coagulopathy. Crit Care. 2020 Jun18;24(1):360.

  3. Gavriilaki E, Brodsky RA. Severe COVID-19infection and thrombotic microangiopathy: successdoes not come easily. Br J Haematol. 2020Jun;189(6):e227−e230. Available at: https://doi.org/10.1111/bjh.16783

  4. Boudhabhay I, Rabant M, Coupry LM, MarchalA, Roumenina LT, El-Karoui K, et al. Case report:Adult post COVID-19 multisystem infl ammatorysyndrome and thrombotic microangiopathy.Research Square [Preprint]. 2020 Sep 16[cited 2021 Sep 18]. Available at: https://doi.org/10.21203/rs.3.rs-76310/v1

  5. Gabarre P, Dumas G, Dupont T, Darmon M,Azoulay E, Zafrani L. Acute kidney injury in criticallyill patients with COVID-19. Intensive CareMed. 2020 Jul;46(7):1339–48.

  6. Jhaveri KD, Meir LR, Flores Chang BS, Parikh R,Wanchoo R, Barilla-LaBarca ML, et al. Thromboticmicroangiopathy in a patient with COVID-19.Kidney Int. 2020 Aug;98(2):509–12.

  7. Falter T, Rossmann H, Menge P, Goetje J, GroenwoldtS, Weinmann A, et al. No evidence for classicthrombotic microangiopathy in COVID-19. JClin Med. 2021 Feb 9;10(4):671.

  8. Cervera R, Asherson RA. Antiphospholipid syndromeassociated with infections: clinical andmicrobiological characteristics. Immunobiology.2005;210(10):735–41.

  9. Rodríguez Y, Novelli L, Rojas M, De Santis M, Acosta-Ampudia Y, Monsalve DM, et al. Autoinfl ammatoryand autoimmune conditions at the crossroad of COVID-19. J Autoimmun. 2020 Nov;114:102506. Availableat: https://doi.org/10.1016/j.jaut.2020.102506.Epub 2020 Jun 16.

  10. Chaturvedi S, Braunstein EM, Yuan X, Yu J,Alexander A, Chen H, et al. Complement activityand complement regulatory gene mutations areassociated with thrombosis in APS and CAPS.Blood. 2020 Jan 23;135(4):239–51.

  11. Bendapudi PK, Hurwitz S, Fry A, Marques MB,Waldo SW, Li A, et al. Derivation and externalvalidation of the PLASMIC score for rapidassessment of adults with thrombotic microangiopathies:a cohort study. Lancet Haematol [Internet].2017 Apr [cited 2021 Sep 18];4(4):e157–e64.Available at: http://dx.doi.org/10.1016/S2352-3026(17)30026-1

  12. Jokiranta TS. HUS and atypical HUS. Blood.2017 May 25;129(21):2847–56.

  13. Ville S, Le Bot S, Chapelet-Debout A, Blancho G,Fremeaux-Bacchi V, Deltombe C, et al. AtypicalHUS relapse triggered by COVID-19. Kidney Int.2021 Jan;99(1):267–8.

  14. Basak R, Wang X, Keane C, Woroniecki R.Atypical presentation of atypical haemolyticuraemic syndrome. BMJ Case Rep. 2018 Feb11;2018:bcr2017222560. Available at: https://doi.org/10.1136/bcr-2017-222560

  15. Valga F, Vega-Díaz N, Macía M, Monzón T,Rodríguez-Pérez JC. Targeting complement insevere coronavirus disease 2019 to addressmicrothrombosis. Clin Kidney J. 2020 Jun12;13(3):477–9.ID




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