Table 1.
Characteristics of 5 patients with COVID-19-associated renal TMA
| At TMA diagnosis | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pt | Sex, age | NK//RT (nephropathy/time from RT) |
Time from COVID-19 diagnosis to TMA | SCr (mg/dL) | Plt (g/L) | Hb (g/dL) | Hapto. (g/L) |
LDH (×ULN) |
Puria (g/L) |
Kidney biopsy | COVID-19 treatment | TMA treatment | Follow-up | Outcome |
| 1 | M, 66 y | NK | 0 d | 10 (HD) | 50 | 9.2 | <0.3 | >ULN | NA | Glomerular and arteriolar thrombi and EC detachment. Mild ATN. |
— | — | 3 mo | HD |
| 2 | M, 71 y | RT (NAS/18 mo) |
12 d | 2.3 | 16 | 6.9 | <0.3 | 1.7 | 1 | Kidney biopsy performed 3 wk after TMA resolution Glomerulosclerosis. GBM duplication. | Oxygen (3 L/min) | PE (n = 4) Eculizumab (day 4; n = 3) Temporary discontinuation of tacrolimus/everolimus. |
1 mo | SCr 1.7 mg/dL (baseline values) |
| 3 | M, 35y | NK | 30 d | 1.9/7.9 (HD) | 11 | 9.7 | <0.3 | 9 | Oliguria | Glomerular and arteriolar thrombi. Mild ATN. | — | PE (n = 11) Eculizumab (day 13; n = 1) |
3 mo | HD |
| 4 | F, 26 y | RT (FSGS/3.5 mo) |
0 d | 7.2 (HD) | 22 | 7.2 | <0.3 | >ULN | NA | — | — | PE (n = 3) Eculizumab (day 21; ongoing) Temporary tacrolimus discontinuation. Rituximab (n = 2) |
4 mo | SCr 4.2 mg/dL Eculizumab continued. |
| 5 | F, 38 y | RT (IgAN/24 mo) |
10d | 3.2 | 103 | 10.4 | <0.3 | 1.6 | 0.8 | Extensive EC detachment from GBM. Mesangiolysis. | — | Decrease in tacrolimus dosage. | 6 mo | SCr 1.8 mg/dL (baseline values) |
ATN, acute tubular necrosis; F, female; FSGS, focal segmental glomerulosclerosis; GBM, glomerular basement membrane; Hapto, haptoglobin; Hb, hemoglobin; HD, hemodialysis; IgAN, immunoglobulin A nephropathy; LDH, lactate dehydrogenase; M, male; NA, not available; NAS, nephroangiosclerosis; NK, native kidneys; PE, plasma exchange; Plt, platelet count; Pt, patient; Puria, proteinuria; RT, renal transplantation; SCr, serum creatinine; ULN, upper limit of normal.