Abstract: PO1893
Thrombotic Microangiopathy, Its Clinical Characteristics, Etiologies, and Outcomes: A Case Series of 33 Patients
Session Information
- Cancer-Related Kidney Injury: Paraneoplastic Syndromes and More
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Khanin, Yuriy, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Jhaveri, Kenar D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Sakhiya, Vipulbhai, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Sharma, Purva D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background
Thrombotic Microangiopathy (TMA), is a pathologic pattern of injury that has a variable presentation and etiologies. Here we present a case series of 33 patients from our academic center with biopsy proven TMA, describe their clinical characteristics and compare the differences between drug- induced TMA and other causes of TMA (Table 1)
Methods
We collected data on clinical characteristics, detailed biopsy findings, etiologies and treatment details for 33 patients at our institution with biopsy proven diagnosis of TMA
Results
The average age of the patients who had a kidney biopsy diagnosis of TMA was 49.18 years. 13/33 patients were African-American. Upon initial assessment, 29/33 patients had acute kidney injury, 9/33 had malignant hypertension (BP> 180/120 on presentation), and 15/33 had MAHA.
In those in which a cause was able to be determined, 12/33 had drug induced TMA with the most common medication being VEGF inhibitors & Tyrosine kinase inhibitors with anti-VEGF properties (8/12). Three patients had TMA secondary to calcineurin inhibitors and one patient had cocaine induced TMA. 3/33 had complement mediated TMA, diagnosed by confirming activation of the alternative complement cascade.
In patients with drug induced TMA, 6/12 patients had improved proteinuria and kidney function after withdrawl of the drug, 3 remained dialysis dependent and 2 were transitioned to home hospice. In the drug induced TMA category, 33% patients were dialysis dependent on discharge from the hospital as opposed to 43% in the non-drug induced TMA category.
Conclusion
Every patient with biopsy proven TMA should undergo a thorough history including medication use and work up, so optimal management can be initiated. In our series, 50% of the patients with drug induced TMA improved after withdrawl of the culprit medication.