Kidney Week

Abstract: FR-PO1118

Clinical Outcomes of Renal Biopsy-Proven Thrombotic Microangiopathy

Session Information

• Glomerular Diseases: Clinical, Outcomes, Trials - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Kang, Eunjeong, Seoul National University Hospital, Seoul, Korea (the Republic of)

Eunjeong Kang,

• Kim, Dong Ki, Seoul National University Hospital, Seoul, Korea (the Republic of)

Dong Ki Kim,

• Oh, Kook-Hwan, Seoul National University Hospital, Seoul, Korea (the Republic of)

Kook-Hwan Oh,

• Joo, Kwon Wook, Seoul National University Hospital, Seoul, Korea (the Republic of)

Kwon Wook Joo,

• Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Yon Su Kim,

• Chin, Ho Jun, Seoul National University Bundang Hospital, Seong nam, Korea (the Republic of)

Ho Jun Chin,

• Lee, Hajeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Hajeong Lee,

Background

The kidney is the most commonly affected organ by thrombotic microangiopathy (TMA)-associated pathologic changes, however, there is lack of studies regarding the clinical outcomes of renal-biopsy proven TMA.

Methods

The patients diagnosed as TMA from 2005 to 2018 in 2 tertiary hospitals were enrolled. Of these 186 patients, children and those who not diagnosed with renal biopsy were excluded. These patients divided into 3 groups according to causes of TMA; typical hemolytic uremic syndrome (HUS), atypical HUS, and secondary TMA. Only 1 patient who classified typical HUS was excluded in the statistical analysis. Renal outcome was defined in 2 ways; renal function deterioration to end-stage renal disease (ESRD) who were depended on dialysis or kidney transplantation (KTPL) and the last measured estimated glomerular filtration rate (eGFR) <45mL/min/1.73m². Age, sex, eGFR rate at diagnosis, systolic blood pressure (SBP), hemoglobin, platelet, albumin, diabetes, hypertension, and classification of TMA were included as covariates in the multivariable analysis.

Results

Among 67 patients, patients who diagnosed with TMA after KTPL were 15(22.3%). Mean age was 54.0±15.5 years and 44(62.0%) were male. During 48.6 months of follow-up, 12 (17.9%) patients died, and 18(26.9%) patients (11 [26.8%] of secondary TMA vs. 7 [26.9%] in aHUS) had maintenance dialysis or KTPL. The patients who had last eGFR <45mL/min/1.73m² was 35(49.3%). There was no significant difference in all-cause mortality (log-rank P=0.293) and ESRD (log rank P=0.378) between atypical HUS and secondary TMA. SBP (hazard ratio [HR] 1.030, 95% confidential interval [CI] 1.006-1.055, P=0.015) and eGFR at diagnosis (HR 0.966, 95% CI 0.939-0.993, P=0.014) were associated with ESRD progression in univariate analysis, however, these associations did not observed in multivariable analysis. eGFR at diagnosis was the only risk factor for the final measured eGFR <45mL/min/1.73m² in multivariate logistic regression (OR 0.952, 95% CI 0.920-0.985, P=0.004). Only age was associated with all-cause mortality (HR 1.079, 95% CI 1.010-1.152, P=0.024) in multivariable analysis.

Conclusion

SBP and eGFR at diagnosis were significantly associated with ESRD progression in renal biopsy-proven TMA. There was no significant difference in all-cause mortality and ESRD progression between atypical HUS and secondary TMA.