Hemolytic uremic syndrome in renal allografted patients treated with cyclosporin

Abstract

The classical triad of hemolytic uremic syndrome (microangiopathic hemolytic anemia, severe thrombopenia, and renal failure) developed de novo in three of our renal transplanted patients under cyclosporin A treatment. The predominant morphologic findings in the grafts consisted of glomerular and arteriolar thrombosis as well as arteriolonecrosis, all features of the syndrome. In one instance, ischemic bowel disease supervened after graft removal and was associated with persistent low grade microangiopathic process. De novo hemolytic uremic syndrome has been reported in patients treated with cyclosporin A following bone marrow or liver transplantation as well as in a few renal graft recipients. This peculiar form of cyclosporin A nephrotoxicity should not be confused with acute rejection of the renal transplant.

Outcome of Plasma Exchange Therapy in Thrombotic Microangiopathy After Renal Transplantation

“…The mean duration of PEx was 8.5 days with a range of 5-23 days. The mean number of PEx sessions required was seven (range [5][6][7][8][9][10][11][12][13][14]. The duration of PEx was determined by improvement in hematological parameters rather than the serum creatinine.…”

“…The incidence of TMA in renal allografts has risen from less than 2% in the precyclosporine era to 3-5% (1,(8)(9)(10)(11)(12) since the introduction of cyclosporine. TMA is a serious problem because it leads to average graft loss rate of 50% (13)(14)(15)(16)(17). Though numerous therapeutic modalities have been used with varying success, current management is based only on anecdotal reports and small case series.…”

“…There have been no controlled trials comparing the efficacy of different treatment options, and established guidelines are not available for the management of TMA in renal allografts. Graft loss rates reported over the last two decades as a result of TMA with various treatment options range from 0 to 100% (13)(14)(15)(16)(17). This wide variation in graft outcome may be the result of lack of uniformity in the diagnosis and treatment and the small numbers of patients in the published case series.…”

“…One of the major problems in evaluating the efficacy or relative role of any of these treatment strategies in allograft TMA is that almost all patients in the published case series have been treated simultaneously with several different therapies and protocols (12)(13)(14)(15)(16)(17). At our institution, we have used a uniform treatment protocol for renal transplant recipients with TMA for the past 12 years, enabling us to assess the effectiveness of this specific treatment.…”

Molecular Profiling of Anemia in Acute Renal Allograft Rejection Using DNA Microarrays

“…Maintenance immunosuppression in these patients (doses represented as mean ∫ standard deviation) consisted of corticosteroids (0.12 ∫ 0.03 mg/kg/day), azathioprine (1.34 ∫ 0.24 mg/kg/day) and cyclosporine (3.6 ∫ 1.5 mg/kg/day). None of these patients had hemolytic-uremic syndrome (14) or hemoglobinopathy to account for their anemia, and the fall in hematocrit was associated with the decline in allograft function. The results presented indicate the ratio of the fluorescence of cDNA probes prepared from each experimental RNA sample to the reference RNA sample.…”