J Nephropathol. 2019;8(3): e27.
doi: 10.15171/jnp.2019.27
  Abstract View: 356
  PDF Download: 148

Original Article

Histopathological features of thrombotic microangiopathies in renal biopsies

Miguel Ernandes Neto 1,2 * ORCiD, Lucas de Moraes Soler 1, Halita Vieira Gallindo Vasconcelos 1, Daniela Cristina dos Santos 3, Rosa Marlene Viero 3 ORCiD, Luis Modelli Gustavo de Andrade 1 ORCiD

1 Department of Internal Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
2 Hospital BP – a Beneficência Portuguesa de São Paulo, São Paulo, São Paulo State, Brazil
3 Department of Pathology, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil

Abstract

Background: Thrombotic microangiopathy (TMA) is a morphologic lesion characterized by thrombi occluding microvasculature related to endothelial injury.

Objectives: This study aimed to assess the association between histopathological findings and etiology of TMA.

Patients and Methods: This cross-sectional study comprised a sample of 34 patients who underwent renal biopsy and received an initial TMA diagnoses resulting in 29 definitive TMA cases. We evaluated the TMA features and clinical histopathological correlation.

Results: The most frequent etiologies were atypical hemolytic uremic syndrome (aHUS) (n= 10; 34.5%), hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli (STECHUS) (n=6; 24.1%) and secondary causes of TMA (n= 12; 41.4%). We found the following histological features; patients with aHUS had thrombi in 60% of biopsies, membranoproliferative glomerulonephritis (MPGN)-like pattern in 20% and ischemia in 20%; patients with STEC-HUS had thrombi (14.3%), MPGN-like pattern (14.3%), endothelial swelling (14.3%) and ischemia (57.1%); patients with secondary etiologies had thrombi (58.3%), endothelial swelling (16.7%), ischemia (16.7%) and MPGN-like pattern (8.3%).

Conclusions: The distribution of classic TMA findings was not related to etiology in spite of microthrombi having been found mostly in aHUS and secondary etiologies, whereas ischemia was found mainly in STEC-HUS. We did not find a histopathological pattern to each etiology of TMA.

Implication for health policy/practice/research/medical education:

In a cross-sectional study on 34 patients with thrombotic microangiopathy (TMA) in renal biopsy, we found the distribution of classic TMA findings was not related to etiology in spite of microthrombi having been found mostly in atypical hemolytic uremic syndrome and secondary etiologies, whereas ischemia was found mainly in hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli.

Please cite this paper as: Ernandes Neto M, Soler LM, Gallindo Vasconcelos HV, dos Santos DC, Viero RM, Modelli de Andrade LG. Histopathological features of thrombotic microangiopathies in renal biopsies. J Nephropathol. 2019;8(3):e22. DOI: 10.15171/jnp.2019.22.

First name
 
Last name
 
Email address
 
Comments
 
Security code


Article Viewed: 356

Your browser does not support the canvas element.


PDF Downloaded: 148

Your browser does not support the canvas element.

Submitted: 07 Apr 2019
Accepted: 20 Jun 2019
First published online: 12 Jul 2019
EndNote EndNote

(Enw Format - Win & Mac)

BibTeX BibTeX

(Bib Format - Win & Mac)

Bookends Bookends

(Ris Format - Mac only)

EasyBib EasyBib

(Ris Format - Win & Mac)

Medlars Medlars

(Txt Format - Win & Mac)

Mendeley Web Mendeley Web
Mendeley Mendeley

(Ris Format - Win & Mac)

Papers Papers

(Ris Format - Win & Mac)

ProCite ProCite

(Ris Format - Win & Mac)

Reference Manager Reference Manager

(Ris Format - Win only)

Refworks Refworks

(Refworks Format - Win & Mac)

Zotero Zotero

(Ris Format - FireFox Plugin)