Advertisement

Thrombotic microangiopathy in a patient with COVID-19

  • Kenar D. Jhaveri
    Correspondence
    Correspondence: Kenar D. Jhaveri, Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 100 Community Drive, Great Neck, New York 11021, USA.
    Affiliations
    Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA

    Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
    Search for articles by this author
  • Lea R. Meir
    Affiliations
    Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
    Search for articles by this author
  • Bessy Suyin Flores Chang
    Affiliations
    Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA

    Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
    Search for articles by this author
  • Rushang Parikh
    Affiliations
    Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA

    Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
    Search for articles by this author
  • Rimda Wanchoo
    Affiliations
    Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA

    Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
    Search for articles by this author
  • Maria Louise Barilla-LaBarca
    Affiliations
    Division of Rheumatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
    Search for articles by this author
  • Vanesa Bijol
    Affiliations
    Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
    Search for articles by this author
  • Negin Hajizadeh
    Affiliations
    Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA

    Pulmonary and Critical Care, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
    Search for articles by this author
      We describe a patient with coronavirus disease 2019 (COVID-19) and clinically significant kidney biopsy-proven thrombotic microangiopathy.
      To read this article in full you will need to make a payment
      ISN Member Login
      Login with your ISN username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chng W.J.
        • Lai H.C.
        • Earnest A.
        • Kuperan P.
        Haematological parameters in severe acute respiratory syndrome.
        Clin Lab Haematol. 2005; 27: 15-20
        • Fan B.E.
        • Chong V.C.L.
        • Chan S.S.W.
        • et al.
        Hematologic parameters in patients with COVID-19 infection.
        Am J Hematol. 2020; 95: E131-E134
        • Zhang Y.
        • Xiao M.
        • Zhang S.
        • et al.
        Coagulopathy and antiphospholipid antibodies in patients with Covid-19.
        N Engl J Med. 2020; 382: e38
        • McNally T.
        • Purdy G.
        • Mackie I.J.
        • et al.
        The use of an anti-beta 2-glycoprotein-I assay for discrimination between anticardiolipin antibodies associated with infection and increased risk of thrombosis.
        Br J Haematol. 1995; 91: 471
        • Gaillard F.
        • Ismael S.
        • Sannier A.
        • et al.
        Tubuloreticular inclusions in COVID-19–related collapsing glomerulopathy.
        Kidney Int. 2020; 98: 241
        • Su H.
        • Yang M.
        • Wan C.
        • et al.
        Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China.
        Kidney Int. 2020; 98: 219-227
        • Caprioli J.
        • Noris M.
        • Brioschi S.
        • et al.
        International Registry of Recurrent and Familial HUS/TTP: genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome.
        Blood. 2006; 108: 1267-1279
        • Hirsch J.S.
        • Ng J.H.
        • Ross D.W.
        • et al.
        Acute kidney injury in patients hospitalized with COVID-19.
        Kidney Int. 2020; 98: 209-218
        • Mohamed M.M.B.
        • Lukitsch I.
        • Torres-Ortiz A.E.
        • et al.
        Acute kidney injury associated with coronavirus disease 2019 in urban New Orleans.
        Kidney360. 2020; 1https://doi.org/10.34067/KID.0002652020

      Linked Article

      • Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China
        Kidney InternationalVol. 98Issue 1
        • Preview
          Although the respiratory and immune systems are the major targets of Coronavirus Disease 2019 (COVID-19), acute kidney injury and proteinuria have also been observed. Currently, detailed pathologic examination of kidney damage in critically ill patients with COVID-19 has been lacking. To help define this we analyzed kidney abnormalities in 26 autopsies of patients with COVID-19 by light microscopy, ultrastructural observation and immunostaining. Patients were on average 69 years (19 male and 7 female) with respiratory failure associated with multiple organ dysfunction syndrome as the cause of death.
        • Full-Text
        • PDF
        Open Access
      • Acute kidney injury in patients hospitalized with COVID-19
        Kidney InternationalVol. 98Issue 1
        • Preview
          The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded.
        • Full-Text
        • PDF
      • Tubuloreticular inclusions in COVID-19–related collapsing glomerulopathy
        Kidney InternationalVol. 98Issue 1
        • Preview
          A 79-year-old man of African ancestry, with a history of hemorrhagic stroke, monoclonal gammopathy of unknown significance, and stage 3 chronic kidney disease due to hypertension, was admitted to Bichat Hospital on day 1 after the first symptom of coronavirus disease 2019 (COVID-19) (fever). Severe acute respiratory syndrome coronavirus 2 polymerase chain reaction was positive on nasal swab. At admission, urinary dipstick was normal and plasma creatinine was 224 μmol/l. On day 4 plasma albumin was at 29 g/l and proteinuria was 11.4 g per gram of urinary creatinine (80% of albumin).
        • Full-Text
        • PDF
      • Thrombotic microangiopathy: COVID-19 or hydroxychloroquine?
        Kidney InternationalVol. 98Issue 6
        • Preview
          I read with great interest the letter to the editor by Jhaveri et al. reporting the first published case report of thrombotic microangiopathy in a patient with coronavirus disease 2019 (COVID-19).1 Although there was a clear temporal relationship between the presentation with COVID-19 and development of thrombotic microangiopathy, I wonder whether the authors considered the possibility of a drug-induced thrombotic microangiopathy, in particular hydroxychloroquine, which was introduced on day 1 of admission.
        • Full-Text
        • PDF
      • The authors reply
        Kidney InternationalVol. 98Issue 6
        • Preview
          We thank Hasbal for the concern expressed1 regarding hydroxychloroquine (HCQ) as the cause of the thrombotic microangiopathy (TMA) in our published case titled “Thrombotic Microangiopathy in a Patient With COVID-19.”2 An immune-mediated thrombotic microangiopathy usually requires ongoing exposure to the drug. In our case, the patient mentioned was on HCQ for a duration of 5 days. The initial 2 doses were prior to admission, and the drug was continued during the initial 3 days of hospitalization.
        • Full-Text
        • PDF