Atypical HUS triggered by COVID-19: A case report

Abstract

We hereby present a case of an atypical hemolytic uremic syndrome (aHUS) precipitated by coronavirus disease 2019 (COVID-19). A 26-year-old male was diagnosed with COVID-19 and acute kidney injury. His kidney biopsy was suggestive of thrombotic microangiopathy. Five sessions of plasmapheresis were done but were discontinued in view of nonrecovery of kidney function. He was then referred for a kidney transplant. On genetic analysis, he was found to have mutations in the complement system (CFHR1 and CFHR3), which suggested this was a case of aHUS precipitated by COVID-19. In view of the high risk of recurrence of the primary disease in live-related kidney donor transplantation, he was advised for simultaneous liver and kidney transplants.

Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review

“…Of these, 24 were reported as COVID-19-related TMA (Table 2) [21–39] , 23 as TTP (Table 3) [40–61] , and 16 as aHUS (Table 4). [62–73]…”

“…Of these, 24 were reported as COVID-19related TMA (Table 2) [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] , 23 as TTP (Table 3) , and 16 as aHUS (Table 4). [62][63][64][65][66][67][68][69][70][71][72][73] [40] The cases of COVID-19-related TMA had a male predominance (58.3%) with a mean age of 44.5 years (interquartile range: 34.75-57.75 years). Seven post-renal transplant patients and 1 post-liver transplant were included in this study.…”

COVID-19 and Glomerular Diseases

“…One patient had low complement factor H and elevated CBb, one had CFHR1 and 3 gene mutations and one had variance of unknown significance in complement factor I and risk polymorphism in complement factor H gene. 90 , 91 , 92 (Supplementary table 6).…”

A case of development of membranous nephropathy against the background of atypical hemolytic-uremic syndrome activated as a result of acute respiratory viral infection

“…При этом поражение почек является одним из ярких клинических проявлений аГУС [2]. Триггером активизации системы комплемента с развитием тромботической микроангиопатии при аГУС чаще являются разнообразные инфекционные процессы, в том числе COVID-19, но могут являться также беременность и роды, отравления и интоксикации, травмы [3,4]. Помимо типичных вариантов поражения почек, при аГУС возможны и более редкие формы в виде С3-гломерулопатий, которые являются самостоятельными проявлением наследственной патологии системы комплемента, но также в редких случаях могут быть в структуре клинических проявлений аГУС.…”

“…Также выявлены явления тубулоинтеристициального воспаления и фиброза с атрофией до 30% площади (рис. [1][2][3][4][5]. Отмечался слабо выраженный гипертрофический тип ремоделирования артерий мышечного и резистивного типов.…”