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Diagnostic Approach to Acute Kidney Injury in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Sonali Gupta, Divyansh Bajaj, Sana Idrees, Joseph Mattana
Thrombotic microangiopathies are rare causes of AKI and require prompt recognition and treatment. Well-described etiologies include thrombotic thrombocytopenic purpura, hemolytic uremic syndrome (which can be subdivided into typical and atypical forms), disseminated intravascular coagulation, malignant hypertension (referred to now as hypertensive emergency), scleroderma renal crisis, and drug toxicity such as can occur with calcineurin inhibitors. The pathogenesis includes thrombosis of capillaries and arterioles due to endothelial damage. Determining the cause of the thrombotic microangiopathy is essential, as this will guide the appropriate therapy [31].
Bleeding Disorders in Pregnancy, Including Thrombocytopenia
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
In patients with a thrombotic microangiopathy, the haematologist should be asked to help distinguish several related causes on the basis of simple coagulation tests, blood film examination, and specific confirmatory tests. The differential diagnosis and important distinguishing features are enumerated in Table 2.
Acute spontaneous non-hemorrhagic adrenal infarction in pregnancy: case-report and literature review
Published in Gynecological Endocrinology, 2023
Sara Ornaghi, Federica Fernicola, Elisabetta Marelli, Mario Perotti, Filiberto Di Gennaro, Irene Cameroni, Eloisa M. Mariani, Angela I. Pincelli, Elisabetta Colciago, Irene Cetin, Patrizia Vergani
Since the underlying cause of AI in pregnancy is believed to be adrenal vein thrombosis [13–15], evaluation for thrombophilia is pivotal. A condition of thrombotic microangiopathy should also be excluded. Abnormal congenital or acquired thrombophilia screening has been identified in several cases of NHAI in pregnant women. Yet, NHAI can also occur in pregnancies with no evidence of thrombophilia disorders, likely due to the increased thrombogenic risk posed by the gestation itself [20]. Nonetheless, additional risk factors for thrombosis can be identified in most of the published cases, including age >35 years, overweight or obese BMI, active smoking, and chronic inflammatory diseases. This suggests that NHAI should be even more suspected if risk factors for thrombosis, alongside gestation, are identified in women presenting with an acute abdomen and inconclusive initial workup.
New-onset diabetic ketoacidosis with purpura fulminans in a child with COVID-19-related multisystem inflammatory syndrome
Published in Infectious Diseases, 2022
Parvathi Parappil, Sushant Ghimire, Apoorv Saxena, Sweta Mukherjee, B. M. John, Vishal Sondhi, P. Sengupta, Suchi Acharya
Immune-triggered, complement-mediated thrombotic microangiopathy is common in patients with SARS-CoV-2-related disease [17,18]. Like the better-known thrombotic microangiopathy syndromes (like HUS, TTP, and DIC), this is characterised by organ failure caused by widespread micro-clots in capillaries and other small vessels [3]. Whether this thrombotic microangiopathy is caused by an autoreactive thrombotic disorder or is secondary to comorbidity (like type 1 diabetes mellitus/diabetic ketoacidosis in our patient) is debatable. Reports of SARS-CoV-2-related thrombotic microangiopathy are emerging in children, wherein thrombotic microangiopathy has been shown to affect both the acute- and post-infectious stage [17]. In our patient, this involvement was in the MIS-C stage. Purpura fulminans, as in our patient, has been scarcely reported in children and adults affected with Covid-19 are likely to be a manifestation of thrombotic microangiopathy [18].
Renal disease associated with chronic myeloproliferative neoplasms
Published in Expert Review of Hematology, 2022
Marko Lucijanic, Ivan Krecak, Rajko Kusec
The largest cohort of renal postmortem histological findings was published in 2021 [12] and was performed in 57 MPN patients [16 PMF, 16 PV, 1 ET, 18 CMML, 6 MPN unclassifiable (MPN-u)]. In contrast to prior studies, this cohort was not selected by clinical indication for kidney biopsy but rather by availability for autopsy. Also, 20% of patients had prior CKD. Idiopathic diffuse glomerulosclerosis not attributable to diabetic or hypertensive nephropathy was present in seven (12%) patients and was the most frequent MPN-attributable finding. Histological features of thrombotic microangiopathy were present in 4/7 of these patients, but no proteinuria nor clinical features of thrombotic microangiopathy were recorded prior to death. No renal involvement was present in nine (16%) patients. Besides these findings, the most frequently encountered histological features were arteriosclerosis (32%), signs of shock (14%), and other nonspecific findings (51%).