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Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review
Coronavirus disease 2019 (COVID-19) can lead to clinically significant multisystem disorders that also affect the kidney. According to recent data, renal injury in the form of thrombotic microangiopathy (TMA) in native kidneys ranks third in frequency. Our review of global literature revealed 46 cas...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9569470/ https://www.ncbi.nlm.nih.gov/pubmed/36232608 http://dx.doi.org/10.3390/ijms231911307 |
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author | Malgaj Vrečko, Marija Aleš Rigler, Andreja Večerić-Haler, Željka |
author_facet | Malgaj Vrečko, Marija Aleš Rigler, Andreja Večerić-Haler, Željka |
author_sort | Malgaj Vrečko, Marija |
collection | PubMed |
description | Coronavirus disease 2019 (COVID-19) can lead to clinically significant multisystem disorders that also affect the kidney. According to recent data, renal injury in the form of thrombotic microangiopathy (TMA) in native kidneys ranks third in frequency. Our review of global literature revealed 46 cases of TMA in association with COVID-19. Among identified cases, 18 patients presented as thrombotic thrombocytopenic purpura (TTP) and 28 cases presented as atypical hemolytic uremic syndrome (aHUS). Altogether, seven patients with aHUS had previously proven pathogenic or likely pathogenic genetic complement abnormalities. TMA occurred at the time of viremia or even after viral clearance. Infection with COVID-19 resulted in almost no or only mild respiratory symptoms in the majority of patients, while digestive symptoms occurred in almost one-third of patients. Regarding the clinical presentation of COVID-19-associated TMA, the cases showed no major deviations from the known presentation. Patients with TTP were treated with plasma exchange (88.9%) or fresh frozen plasma (11.1%), corticosteroids (88.9%), rituximab (38.9%), and caplacizumab (11.1%). Furthermore, 53.6% of patients with aHUS underwent plasma exchange with or without steroid as initial therapy, and 57.1% of patients received a C5 complement inhibitor. Mortality in the studied cohort was 16.7% for patients with TTP and 10.7% for patients with aHUS. The exact role of COVID-19 in the setting of COVID-19-associated TMA remains unclear. COVID-19 likely represents a second hit of aHUS or TTP that manifests in genetically predisposed individuals. Early identification of the TMA subtype and appropriate prompt and specific treatment could lead to good outcomes comparable to survival and recovery statistics for TMA of all causes. |
format | Online Article Text |
id | pubmed-9569470 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-95694702022-10-17 Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review Malgaj Vrečko, Marija Aleš Rigler, Andreja Večerić-Haler, Željka Int J Mol Sci Review Coronavirus disease 2019 (COVID-19) can lead to clinically significant multisystem disorders that also affect the kidney. According to recent data, renal injury in the form of thrombotic microangiopathy (TMA) in native kidneys ranks third in frequency. Our review of global literature revealed 46 cases of TMA in association with COVID-19. Among identified cases, 18 patients presented as thrombotic thrombocytopenic purpura (TTP) and 28 cases presented as atypical hemolytic uremic syndrome (aHUS). Altogether, seven patients with aHUS had previously proven pathogenic or likely pathogenic genetic complement abnormalities. TMA occurred at the time of viremia or even after viral clearance. Infection with COVID-19 resulted in almost no or only mild respiratory symptoms in the majority of patients, while digestive symptoms occurred in almost one-third of patients. Regarding the clinical presentation of COVID-19-associated TMA, the cases showed no major deviations from the known presentation. Patients with TTP were treated with plasma exchange (88.9%) or fresh frozen plasma (11.1%), corticosteroids (88.9%), rituximab (38.9%), and caplacizumab (11.1%). Furthermore, 53.6% of patients with aHUS underwent plasma exchange with or without steroid as initial therapy, and 57.1% of patients received a C5 complement inhibitor. Mortality in the studied cohort was 16.7% for patients with TTP and 10.7% for patients with aHUS. The exact role of COVID-19 in the setting of COVID-19-associated TMA remains unclear. COVID-19 likely represents a second hit of aHUS or TTP that manifests in genetically predisposed individuals. Early identification of the TMA subtype and appropriate prompt and specific treatment could lead to good outcomes comparable to survival and recovery statistics for TMA of all causes. MDPI 2022-09-25 /pmc/articles/PMC9569470/ /pubmed/36232608 http://dx.doi.org/10.3390/ijms231911307 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Malgaj Vrečko, Marija Aleš Rigler, Andreja Večerić-Haler, Željka Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review |
title | Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review |
title_full | Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review |
title_fullStr | Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review |
title_full_unstemmed | Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review |
title_short | Coronavirus Disease 2019-Associated Thrombotic Microangiopathy: Literature Review |
title_sort | coronavirus disease 2019-associated thrombotic microangiopathy: literature review |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9569470/ https://www.ncbi.nlm.nih.gov/pubmed/36232608 http://dx.doi.org/10.3390/ijms231911307 |
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