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Article Dans Une Revue Kidney International Année : 2024

Assessment of epidemiology and outcomes of adult patients with kidney-limited thrombotic microangiopathies.

1 Service de néphrologie et immunologie clinique [CHRU Tours]
2 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
3 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
4 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
5 CoRaKID - Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
6 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
7 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
8 Service de Soins Intensifs [CHU Rouen]
9 Hôpital Necker - Enfants Malades [AP-HP]
10 Centre hospitalier [Valenciennes, Nord]
11 UT - Université de Tours
12 CHU Saint-Antoine [AP-HP]
13 CHU Amiens-Picardie
14 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
15 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
16 CHU Angers - Centre Hospitalier Universitaire d'Angers
17 Fibrose hépatique et cancer du foie
18 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
19 SPHERE - MethodS in Patients-centered outcomes and HEalth ResEarch
20 Association ECHO [Expansion des Centres d’Hémodialyse de l’Ouest]
21 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
22 Hôpital Foch [Suresnes]
23 ITERT - Institut de Transplantation et de Recherche en Transplantation [CHU Nantes]
24 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
25 Team 3 - U1064 Inserm - CR2TI - Team 3 : Integrative transplantation, HLA, Immunology and genomics of kidney injury
26 HEGP - Hôpital Européen Georges Pompidou [APHP]
27 T2i - Transplantation, Immunologie, Inflammation [Tours]
Alain Wynckel
  • Fonction : Auteur
Manon Martins
  • Fonction : Auteur
Juliet Schurder
  • Fonction : Auteur
Christelle Barbet
  • Fonction : Auteur
Bénédicte Sautenet
  • Fonction : Auteur
Sophie Caillard
  • Fonction : Auteur
Vincent Vuiblet
  • Fonction : Auteur

Résumé

Thrombotic microangiopathies (TMA) are usually associated with hematological features (RH-TMA). The epidemiology of TMA limited to kidneys (RL-TMA) is unclear Therefore, patients with TMA and native kidney biopsies were identified during 2009-2022 in 20 French hospitals and results evaluated. RL-TMA was present in 341/757 (45%) patients and associated with lower creatinine levels (median 184 vs 346 μmol/L) than RH-TMA. RL-TMA resulted from virtually all identified causes, more frequently from anti-VEGF treatment and hematological malignancies, but less frequently from shigatoxin-associated hemolytic uremic syndrome (HUS), systemic sclerosis, gemcitabine and bacterial infection, and even less frequently when three or more causes/triggers were combined (RL-TMA: 5%; RH-TMA: 12%). RL-TMA was associated with significantly lower major cardiovascular events (10% vs 20%), kidney replacement therapy (23% vs 43%) and death (12% vs 20%) than RH-TMA during follow-up (median 28 months). Atypical HUS (aHUS) was found in 326 patients (RL-TMA: 43%, RH-TMA: 44%). Among the 69 patients with proven complement-mediated aHUS, eculizumab (anti-C5 therapy) was used in 43 (62%) (RL-TMA: 35%; RH-TMA: 71%). Among the 257 other patients with aHUS, including 51% with RL-TMA, eculizumab was used in 29 but with unclear effects of this treatment. Thus, RL-TMA represent a very high proportion of patients with TMA and results from virtually all known causes of TMA, includes 25% of patients with complement-mediated aHUS. Adverse outcomes of RL-TMA are lower compared to RH-TMA, but remain significant. Anti-C5 therapy was rarely used in RL-TMA, even in proven complement-mediated aHUS, and its effects remain to be assessed.
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Dates et versions

hal-04494315 , version 1 (07-03-2024)

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Citer

Valentin Maisons, Anna Duval, Laurent Mesnard, Marie Frimat, Fadi Fakhouri, et al.. Assessment of epidemiology and outcomes of adult patients with kidney-limited thrombotic microangiopathies.. Kidney International, 2024, ⟨10.1016/j.kint.2024.02.014⟩. ⟨hal-04494315⟩
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