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J Nephropathol. 2019;8(3): e27.
doi: 10.15171/jnp.2019.27

Scopus ID: 85115204488
  Abstract View: 4758
  PDF Download: 1470

Original Article

Histopathological features of thrombotic microangiopathies in renal biopsies

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

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
*Corresponding Author: Email: m_ernandes@yahoo.com.br

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.

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Submitted: 07 Apr 2019
Accepted: 20 Jun 2019
ePublished: 12 Jul 2019
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