Thrombotic microangiopathy associated with arboviral infection: Report of 3 cases.

Autor: Coelho Júnior JL; Department of Nephrology, University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil., Israel KCP; Tropical Medicine Foundation Dr. Heitor Vieira Dourado/State University of Amazonas (UEA), Manaus, Brazil., Machado CEE; Department of Nephrology, University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil., Muniz MPR; Department of Nephrology, University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil., Gatto GC; Nephrology Service, University Hospital of Brasilia, University of Brasília (HUB-UNB), Brasília, Brazil., Barros FHS; Nephrology Service, High Complexity State Hospital of Maranhão Dr. Carlos Macieira (HCM), São Luís, Brazil., Cunha KA; Department of Nephrology, University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil., de Lacerda MVG; Tropical Medicine Foundation Dr. Heitor Vieira Dourado/State University of Amazonas (UEA), Manaus, Brazil., Neves PDMM; Nephrology Division, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil., Silva GEB; Department of Pathology, Ribeirão Preto Medical School, University of São Paulo (FM-USP), Ribeirão Preto, Brazil.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2021 Oct 14; Vol. 15 (10), pp. e0009790. Date of Electronic Publication: 2021 Oct 14 (Print Publication: 2021).
DOI: 10.1371/journal.pntd.0009790
Abstrakt: Dengue fever and chikungunya are viral diseases that have spread rapidly throughout the world in recent decades. The occurrence of complications is well known, including prerenal acute kidney injury (AKI), which is usually thought to be caused by dehydration and fluid loss. Thrombotic microangiopathy (TMA) is an uncommon aggravation of dengue fever and chikungunya, with only a few cases described in the medical literature. The aim of this study is to present 3 cases of TMA associated with arboviral infection. Three patients with clinical history, laboratory test, and kidney biopsy results compatible with TMA were selected for the study, 2 of whom had a serological diagnosis of dengue fever and 1 of chikungunya. The 3 patients were followed up at the Federal University of Maranhão Hospital's Nephrology Service in 2018. A targeted gene panel sequencing (TGPS) plus multiple to atypical hemolytic uremic syndrome (aHUS) multiplex ligation-dependent probe amplification (MLPA) was performed in 2 of the patients and revealed in the patient 1 a heterozygous pathogenic variant in the gene THBD, as well as heterozygous deletions in CFH, CFHR1, and CFHR3. In the patient 2, there were heterozygous pathogenic variant in the genes CFI and CFB, in addition to heterozygous deletions in the genes CFHR1 and CFHR3. Both received treatment with eculizumab and undergone recovery of renal function. The third patient had TMA not classified as either aHUS or thrombotic thrombocytopenic purpura (TTP); he abandoned the treatment and returned to the service after 2 years for a dialysis emergency. Patients with arboviral infectious disease and changes that suggest TMA should have appropriate support to establish early diagnosis and useful treatment.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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