Abstract: FR-PO0436
Beyond the 90-Day Rule: Delayed Renal Recovery After 13 Months of Dialysis-Dependent AKI in Secondary Thrombotic Microangiopathic Hemolytic Anemia
Session Information
- AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Khan, Sobia, Stony Brook University, Stony Brook, New York, United States
Introduction
90-day threshold for defining irreversible dialysis-dependent acute kidney injury (AKI-D) is widely used but not validated in complement-mediated thrombotic microangiopathy (TMA). Eculizumab, a C5a-inhibitor arrests complement-driven endothelial injury, but structural renal repair, tubular regeneration and glomerular endothelial recovery happen over a long biological timescale.
Case Description
34-year-old female with abdominal pain, nausea and vomiting. Labs: serum creatinine (SCr)15.9 mg/dL, platelets 83K, LDH 761, and schistocytes. Thrombotic thrombocytopenia (TTP) was excluded (ADAMST13~ 54%). She was pre-emptively treated with Eculizumab and initiated on hemodialysis (HD) for volume overload and uremia. Kidney biopsy showed subacute TMA with ischemic glomerular collapse and arteriolar “onion-skinning with mucoid intimal edema, intimal schistocytes, rare microthrombi, and arteriolar hyalinosis. Hematologic remission was rapid, but dialysis dependence persisted. Her urine output slowly improved over the course of months and remained ~400 mL/day. She maintained biochemical stability and no hemolysis.
Dialysis liberation trial was initiated based on preserved urine output, hematologic remission, and stable electrolytes. HD was discontinued after 13 months. Creatinine stabilized at ~3–4.5 mg/dL without complications. Patient stayed off dialysis.
Discussion
In TMA, kidney recovery may be delayed and dissociated from hematologic response. A stable creatinine plateau with preserved urine output may indicate ongoing repair rather than irreversible injury. Preserved urine output, hematologic remission, and biochemical stability support continued reassessment and may allow late dialysis independence. Preserved urine output during hemodialysis (HD) dependence is an underrecognized signal of residual nephron viability that should not be ignored.
Fig 1: Serum creatinine trajectory demonstrating delayed renal recovery. Meaningful recovery achieved after 13 months