Indicators of Acute and Persistent Renal Damage in Adult Thrombotic MicroangiopathyReport as inadecuate

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Thrombotic microangiopathies TMA in adults such as thrombotic thrombocytopenic purpura TTP and hemolytic uremic syndrome HUS are life-threatening disorders if untreated. Clinical presentation is highly variable and prognostic factors for clinical course and outcome are not well established.


We performed a retrospective observational study of 62 patients with TMA, 22 males and 40 females aged 16 to 76 years, treated with plasma exchange at one center to identify clinical risk factors for the development of renal insufficiency.


On admission, 39 of 62 patients 63% had acute renal failure ARF with 32 patients 52% requiring dialysis treatment. High systolic arterial pressure SAP, p = 0.009 or mean arterial pressure MAP, p = 0.027 on admission was associated with acute renal failure. Patients with SAP>140 mmHg on admission had a sevenfold increased risk of severe kidney disease OR 7.464, CI 2.097–26.565. MAP>100 mmHg indicated a fourfold increased risk for acute renal failure OR 4.261, CI 1.400–12.972. High SAP, diastolic arterial pressure DAP, and MAP on admission were also independent risk factors for persistent renal insufficiency with the strongest correlation for high MAP. Moreover, a high C-reactive protein CRP level on admission correlated with renal failure in the course of the disease p = 0.003. At discharge, renal function in 11 of 39 patients 28% had fully recovered, 14 patients 23% remained on dialysis, and 14 patients 23% had non-dialysis-dependent chronic kidney disease. Seven patients 11% died. We identified an older age as risk factor for death.


High blood pressure as well as high CRP serum levels on admission are associated with renal insufficiency in TMA. High blood pressure on admission is also a strong predictor of sustained renal insufficiency. Thus, adult TMA patients with high blood pressure may require special attention to prevent persistent renal failure.

Author: Firuseh Dierkes , Nikolaos Andriopoulos , Christoph Sucker, Kathrin Kuhr, Markus Hollenbeck, Gerd R. Hetzel, Volker Burst, Sven T



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