Kidney Week

Abstract: TH-PO102

A Unique Presentation of Thrombotic Microangiopathy with Cardiac Tamponade

Session Information

• AKI: Clinical, Outcomes, and Trials - Epidemiology and Pathophysiology
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Pino Domenech, Eduardo, Lenox Hill Hospital, New York, New York, United States

Eduardo Pino Domenech, MD

• Moses, Andrew A., Lenox Hill Hospital, New York, New York, United States

Andrew A. Moses, MD, MA, FASN

• Rosenstock, Jordan L., Lenox Hill Hospital, New York, New York, United States

Jordan L. Rosenstock, MD, FASN

• DeVita, Maria V., Lenox Hill Hospital, New York, New York, United States

Maria V. DeVita, MD, FASN

• Khan, Tasnin M., Lenox Hill Hospital, New York, New York, United States

Tasnin M. Khan, DO

• Kana, Tina, Lenox Hill Hospital, New York, New York, United States

Tina Kana, DO

Introduction

We are presenting a unique case of TMA that was complicated by cardiac tamponade.

Case Description

55-year-old female with hypertension, chronic tooth infection, multiple ED visits over the past month for facial and bilateral leg swelling. Workup revealed creatinine of 2.1mg/dl rising to 3.1mg/dl with 2.9g of proteinuria and hematuria. She denied diarrhea, dysuria, abdominal pain, cough, fever, headache or confusion during the last month. Lab data revealed platelets 156K and hemoglobin 8.6g/dl, with a normal coagulation panel. POCUS performed showing kidney with mildly increased echogenicity and normal size; also pericardial effusion noted. Formal Echo revealed a moderate pericardial effusion with systolic invagination of the right atrium, an evidence of Cardiac Tamponade(CT). Urgent pericardiocentesis was performed, showing hemorrhagic pericardial effusion and hemosiderin laden macrophages suggestive of subacute hemorrhage and delayed cardiac tamponade. Glomerulonephritis and infectious panel were normal, including C3/C4. sCr increased to 4.48mg/dl, platelets and hemoglobin decreased to103K and 7.6g/dl respectively; LDH level was 789 and Haptoglobin<10, with abundant schistocytes in peripheral smear. Kidney biopsy showed thrombotic microangiopathy(TMA). Atypical Hemolytic Uremic Syndrome complement functional panel resulted non-diagnostic, AdamsTS13 activity was normal, and genetic testing is pending. Patient received Eculizumab and started on dialysis. Platelets and Haptoglobin, normalized in one week after Eculizumab therapy, LDH decreased to 582, and continue down trending in further labs.

Discussion

Pericardial effusion is not a common complication of TMA, and only a few cases are reported, mostly in the pediatric literature. Many of these cases are typical Hemolytic Uremic Syndrome with confirmed E. coli O157:H7 infection, or after hematopoietic stem cell transplantation, with only one case reported complicated by CT.
This case proves the wide variety of clinical signs/symptoms, laboratory, and radiologic findings that TMA can have. Prompt diagnosis with kidney biopsy is key to confirm the diagnosis. Early initiation of specific therapy correlates with higher chances of better outcomes.