Title :

Assessment of epidemiology and outcomes of adult patients with kidney-limited thrombotic microangiopathies.

Author(s) :

Maisons, Valentin [Auteur]
Service de néphrologie et immunologie clinique [CHRU Tours]
Centre Hospitalier Régional Universitaire de Tours [CHRU Tours]
Duval, Anna [Auteur]
Centre de Recherche des Cordeliers [CRC (UMR_S_1138 / U1138)]
Centre Hospitalier Universitaire [Strasbourg] [CHU Strasbourg]
Mesnard, Laurent [Auteur]
Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée [CoRaKID]
Frimat, Marie [Auteur]
Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]
Fakhouri, Fadi [Auteur]
Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne] [CHUV]
Grangé, Steven [Auteur]
Service de Soins Intensifs [CHU Rouen]
Servais, Aude [Auteur]
Hôpital Necker - Enfants Malades [AP-HP]
Cartery, Claire [Auteur]
Centre hospitalier [Valenciennes, Nord]
Fauchier, Laurent [Auteur]
Université de Tours [UT]
Coppo, Paul [Auteur]
CHU Saint-Antoine [AP-HP]
Titeca-Beauport, Dimitri [Auteur]
CHU Amiens-Picardie
Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 [MP3CV]
Fage, Nicolas [Auteur]
MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale [MITOVASC]
Centre Hospitalier Universitaire d'Angers [CHU Angers]
Delmas, Yahsou [Auteur]
Fibrose hépatique et cancer du foie
Quérard, Anne-Hélène [Auteur]
Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon [CHD Vendée]
MethodS in Patients-centered outcomes and HEalth ResEarch [SPHERE]
Seret, Guillaume [Auteur]
Association ECHO [Expansion des Centres d’Hémodialyse de l’Ouest]
Bobot, Mickaël [Auteur]
Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research [C2VN]
Le Quintrec, Moglie [Auteur]
Hôpital Foch [Suresnes]
Ville, Simon [Auteur]
Institut de Transplantation et de Recherche en Transplantation [CHU Nantes] [ITERT]
Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology [U1064 Inserm - CR2TI]
Team 3 : Integrative transplantation, HLA, Immunology and genomics of kidney injury [Team 3 - U1064 Inserm - CR2TI]
von Tokarski, Florent [Auteur]
Centre Hospitalier Régional Universitaire de Tours [CHRU Tours]
Service de néphrologie et immunologie clinique [CHRU Tours]
Chauvet, Sophie [Auteur]
Centre de Recherche des Cordeliers [CRC (UMR_S_1138 / U1138)]
Hôpital Européen Georges Pompidou [APHP] [HEGP]
Wynckel, Alain [Auteur]
Martins, Manon [Auteur]
Schurder, Juliet [Auteur]
Barbet, Christelle [Auteur]
Sautenet, Bénédicte [Auteur]
Gatault, Philippe [Auteur]
Membrane Signalling and Inflammation in reperfusion Injuries [ISCHEMIA ]
Caillard, Sophie [Auteur]
Vuiblet, Vincent [Auteur]
Halimi, Jean-Michel [Auteur]
Membrane Signalling and Inflammation in reperfusion Injuries [ISCHEMIA ]

Journal title :

Kidney International

Publisher :

Nature Publishing Group

Publication date :

2024-02

ISSN :

0085-2538

English keyword(s) :

Biopsy
Epidemiology
Kidney
Malignant Hypertension
Monoclonal gammopathy
Thrombotic Microangiopathies

HAL domain(s) :

Sciences du Vivant [q-bio]/Médecine humaine et pathologie

English abstract : [en]

Thrombotic microangiopathies (TMA) are usually associated with hematological features (RH-TMA). The epidemiology of TMA limited to kidneys (RL-TMA) is unclear Therefore, patients with TMA and native kidney biopsies were ...
Show more >Thrombotic microangiopathies (TMA) are usually associated with hematological features (RH-TMA). The epidemiology of TMA limited to kidneys (RL-TMA) is unclear Therefore, patients with TMA and native kidney biopsies were identified during 2009-2022 in 20 French hospitals and results evaluated. RL-TMA was present in 341/757 (45%) patients and associated with lower creatinine levels (median 184 vs 346 μmol/L) than RH-TMA. RL-TMA resulted from virtually all identified causes, more frequently from anti-VEGF treatment and hematological malignancies, but less frequently from shigatoxin-associated hemolytic uremic syndrome (HUS), systemic sclerosis, gemcitabine and bacterial infection, and even less frequently when three or more causes/triggers were combined (RL-TMA: 5%; RH-TMA: 12%). RL-TMA was associated with significantly lower major cardiovascular events (10% vs 20%), kidney replacement therapy (23% vs 43%) and death (12% vs 20%) than RH-TMA during follow-up (median 28 months). Atypical HUS (aHUS) was found in 326 patients (RL-TMA: 43%, RH-TMA: 44%). Among the 69 patients with proven complement-mediated aHUS, eculizumab (anti-C5 therapy) was used in 43 (62%) (RL-TMA: 35%; RH-TMA: 71%). Among the 257 other patients with aHUS, including 51% with RL-TMA, eculizumab was used in 29 but with unclear effects of this treatment. Thus, RL-TMA represent a very high proportion of patients with TMA and results from virtually all known causes of TMA, includes 25% of patients with complement-mediated aHUS. Adverse outcomes of RL-TMA are lower compared to RH-TMA, but remain significant. Anti-C5 therapy was rarely used in RL-TMA, even in proven complement-mediated aHUS, and its effects remain to be assessed.Show less >

Language :

Anglais

Popular science :

Non

Collections :

• Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement (RID-AGE) - U1167

Source :

Harvested from HAL