Diagnostic clues in atypical hemolytic uremic syndrome: a case report

Authors

  • M. Luquin Irigoyen Servicio de Análisis Clínicos. Hospital Universitario de Navarra. Servicio Navarro de Salud-Osasunbidea. Pamplona. España.
  • C. Armendariz Brugos Servicio de Análisis Clínicos. Hospital Universitario de Navarra. Servicio Navarro de Salud-Osasunbidea. Pamplona. España.
  • M. Vallejo Ruiz Servicio de Análisis Clínicos. Hospital Universitario de Navarra. Servicio Navarro de Salud-Osasunbidea. Pamplona. España.

DOI:

https://doi.org/10.23938/ASSN.1006

Keywords:

Atypical hemolytic-uremic síndrome, Microangiopathic hemolytic anemia, Complement pathway alternative, Complement System Proteins, Eculizumab

Abstract

Atypical hemolytic uremic syndrome (aHUS) is a clinical entity characterized by non-immune hemolytic anemia, thrombocytopenia and renal failure, in which lesions are mediated by a systemic thrombotic microangiopathy. It is a rare pathology whose origin is a complement system deregulation due to mutations in its genes that lead to uncontrolled activation of C5 and the formation of the membrane attack complex.­ Its correct diagnosis allows us to prescribe the treatment based on Eculizumab, a C5 inhibitor.

We report the case of a pregnant patient with aHUS, with the aim of highlighting the importance of early differential diagnosis to establish an early and effective treatment of this pathology. The pathophysiology, diagnosis and genetic study are updated, as well as the therapeutic management of aHUS.

Downloads

Download data is not yet available.

References

NORIS M, REMUZZI G. Atypical hemolytic-uremic syndrome. N Engl J Med 2009; 361: 1676-1687. https://doi.org/10.1056/NEJMra0902814.

TIMMERMANS S, WERION A, SPAANDERMAN M, REUTELINGSPERGER C, DAMOISEAUX J, MORELLE J et al. The natural course of pregnancies in women with primary atypical haemolytic uraemic syndrome and asymptomatic relatives. Br J Haematol 2020; 190: 442-449. https://doi.org/10.1111/bjh.16626.

CAMPISTOL JM, ARIAS M, ARICETA G, BLASCO M, ESPINOSA L, ESPINOSA M et al. Actualización en síndrome hemolítico urémico atípico: diagnóstico y tratamiento. Documento de consenso. Nefrología 2015; 35: 421-447. https://doi.org/10.1016/j.nefro.2015.07.005.

NORIS M, CAPRIOLI J, BRESIN E, MOSSALI C, PIANETTI G, GAMBA S et al. Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype. Clin J Am Soc Nephrol 2010; 5: 1844-1859. https://doi.org/10.2215/CJN.02210310

PEREIRA-VICTORIO CJ, VÁZQUEZ-MOLINERO A, LIZÁN-GARCÍA M, LUIS J, GONZÁLEZ B. Síndrome de HELLP en atención primaria. Med Gen y Fam 2016; 5: 83-90. http://dx.doi.org/10.1016/j.mgyf.2016.02.002

FAKHOURI F, ROUMENINA L, PROVOT F, SALLÉE M, CAILLARD S, COUZI L et al. Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol 2010; 21: 859-867.

https://doi.org/10.1681/ASN.2009070706.

NESTER C, BARBOUR T, RODRIGUEZ DE CORDOBA S, DRAGON-DUREY MA, FREMEAUX-BACCHI V, GOODSHIP T et al. Atypical aHUS: state of the art. Mol Immunol 2015; 67: 31-42. https://doi.org/10.1016/j.molimm.2015.03.246.

SHAH N, RUTHERFORD C, MATEVOSYAN K, SHEN YM, SARODE R. Role of ADAMTS13 in the management of thrombotic microangiopathies including thrombotic thrombocytopenic purpura (TTP). Br J Haematol 2013; 163: 514-519. https://doi.org/10.1111/bjh.12569.

NORIS M, BRESIN E, MELE C, REMUZZI G, ADAM M, ARDINGER H et al. Genetic atypical hemolytic-uremic syndrome. En: GeneReviews. Seattle (WA): University of Washington, 2021.

ROUMENINA L, FRIMAT M, MILLER E, PROVOT F, DRAGON-DUREY MA, BORDEREAU P et al. A prevalent C3 mutation in aHUS patients causes a direct C3 convertase gain of function. Blood 2012; 119: 4182–4191. https://doi.org/10.1182/blood-2011-10-383281.

MARTINEZ-BARRICARTE R, MEIKE HEURICH, LÓPEZ-PERROTE A, TORTAJADA A, PINTO S, LÓPEZ-TRASCASA M et al. The molecular and structural bases for the association of complement C3 mutations with atypical hemolytic uremic syndrome. Mol Immunol 2015; 66: 263-273. https://doi.org/10.1016/j.molimm.2015.03.248.

BRESIN E, RURALI E, CAPRIOLI J, SANCHEZ-CORRAL P, FREMEAUX-BACCHI V, RODRIGUEZ DE CORDOBA S et al. Combined complement gene mutations in atypical hemolytic uremic syndrome influence clinical phenotype. J Am Soc Nephrol 2013; 24: 475-486. https://doi.org/10.1681/ASN.2012090884.

Agencia Europea del Medicamento. Soliris (eculizumab). Ficha técnica. https://www.ema.europa.eu/en/documents/product-information/soliris-epar-product-information_es.pdfa 2012.

FAKHOURI F, FILA M, HUMMEL A, RIBES D, SELLIER-LECLERC A, VILLE S et al. Eculizumab discontinuation in children and adults with atypical hemolytic-uremic syndrome: a prospective multicenter study. Blood 2021; 137: 2438-2449. http://doi.org/10.1182/blood.2020009280

Published

2022-08-17

How to Cite

Luquin Irigoyen, M., Armendariz Brugos, C., & Vallejo Ruiz, M. (2022). Diagnostic clues in atypical hemolytic uremic syndrome: a case report. Anales Del Sistema Sanitario De Navarra, 45(2), e1006. https://doi.org/10.23938/ASSN.1006

Issue

Section

Clinical notes