Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
DOI:
https://doi.org/10.33448/rsd-v12i2.39964Keywords:
COVID-19; SARS-CoV-2; Thrombosis; Acute kidney injury.Abstract
Objective: To describe a case of thrombotic microangiopathy due to COVID-19 superimposed on non-dialytic CKD, who was under medical care by the Nephrology ward team at a referral center in northeastern Brazil. Method: A case report study in which we present a case of TMA with severe kidney damage triggered by SARS-CoV-2 in a patient with previous chronic nephropathy, who evolved with the need for hemodialysis. Results: TAM associated with SARS-CoV-2 seems to be related to the uncontrolled activation of an alternative complement pathway and the alteration of the integrity of the vascular endothelium, leading to the release of inflammatory cytokines and consequent activation of the local coagulation cascade. To improve the outcome of these patients, it is necessary to quickly identify the TMA, offer supportive therapy and, when applicable, specific treatment according to the underlying pathophysiology. Discussion: COVID-19 can manifest as multiorgan dysfunction, with pulmonary involvement being the most common. Exaggerated immune response in the form of unrestricted complement activation and cytokine storm may be a key factor for widespread organ damage. There may be hypercoagulability and a high rate of thrombosis. Although macrovascular thrombosis is common in these individuals, the frequent finding of microvascular thromboses raises the possibility of thrombotic microangiopathy (TAM) as a contributing factor to multiorgan complications, including the kidney. Conclusion: The management of TMA is a challenge and survival rates are directly related to the implementation time of adequate treatment.
References
Andrade, D. (2020). Mecanismos envolvidos na trombogênese em pacientes com COVID-19. Parte 2 - Síndrome antifosfolípide (SAF) e infecção por SARS-CoV2 (COVID). Revista Paulista de Reumatologia, 2020 jul-set;19(3), 22–26.
Bascuñana, A., Mijaylova, A., Vega, A., Macías, N., Verde, E., Rodríguez-Ferrero, M. L., Delgado, A., Carbayo, J., & Goicoechea, M. (2020). Thrombotic Microangiopathy in a Kidney Transplant Patient With COVID-19. Kidney Medicine.
Bevacqua, Raúl J., & Perrone, Sergio V.. (2020). COVID-19: relación entre enzima convertidora de angiotensina 2, sistema cardiovascular y respuesta inmune del huésped. Insuficiencia cardíaca, 15(2), 34-51.
Branco, C. G., Duarte, I., Gameiro, J., Costa, C., Marques, F., Oliveira, J., Bernardo, J., Fonseca, J. N., Carreiro, C., Braz, S., & Lopes, J. A. (2022). Presentation and outcomes of chronic kidney disease patients with COVID-19. Brazilian Journal of Nephrology, 44(3), 321–328.
Brandão, S. C. S., Godoi, E. T. A. M., Ramos, J. de O. X., Melo, L. M. M. P. de, & Sarinho, E. S. C. (2020). COVID-19 grave: entenda o papel da imunidade, do endotélio e da coagulação na prática clínica. Jornal Vascular Brasileiro, 19.
Facca, T. A., Kirsztajn, G. M., & Sass, N. (2012). Pré-eclâmpsia (indicador de doença renal crônica): da gênese aos riscos futuros. Brazilian Journal of Nephrology, 34, 87–93.
George, J. N., & Nester, C. M. (2014). Syndromes of Thrombotic Microangiopathy. New England Journal of Medicine, 371(7), 654–666.
Gouvea, E. P. et al. Metodologia ativa: um estudo de caso sobre a ferramenta glossário em ambientes virtuais de educação a distância. REGS - Revista Educação, Gestão e Sociedade: revista da Faculdade Eça de Queirós, ISSN 2179-9636, v. 6, n. 22, junho de 2016. Disponível em: http://uniesp.edu.br/sites/_biblioteca/ Acesso em: 19 jan. 2023.
Gomes, G. M. T. (2022). Gravidez e comprometimento renal, ainda uma incógnita. Brasília Médica, 59.
Helms, J., Tacquard, C., Severac, F., Leonard-Lorant, I., Ohana, M., Delabranche, X., Merdji, H., Clere-Jehl, R., Schenck, M., Fagot Gandet, F., Fafi-Kremer, S., Castelain, V., Schneider, F., Grunebaum, L., Anglés-Cano, E., Sattler, L., Mertes, P.-M., & Meziani, F. (2020). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Medicine, 46(6), 1089–1098.
Henry, B. M., Vikse, J., Benoit, S., Favaloro, E. J., & Lippi, G. (2020). Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis. Clinica Chimica Acta, 507, 167–173.
Kipshidze, N., Dangas, G., White, C. J., Kipshidze, N., Siddiqui, F., Lattimer, C. R., Carter, C. A., & Fareed, J. (2020). Viral Coagulopathy in Patients With COVID-19: Treatment and Care. Clinical and Applied Thrombosis/Hemostasis, 26, 107602962093677.
Korotchaeva, J., Chebotareva, N., Andreeva, E., Sorokin, Y., McDonnell, V., Stolyarevich, E., & Moiseev, S. (2021). Thrombotic Microangiopathy Triggered by COVID-19: Case Reports. Nephron, 146(2), 197–202.
Lana, R. M., Coelho, F. C., Gomes, M. F. da C., Cruz, O. G., Bastos, L. S., Villela, D. A. M., & Codeço, C. T. (2020). Emergência do novo coronavírus (SARS-CoV-2) e o papel de uma vigilância nacional em saúde oportuna e efetiva. Cadernos de Saúde Pública, 36(3), e00019620.
Magro, C., Mulvey, J. J., Berlin, D., Nuovo, G., Salvatore, S., Harp, J., Baxter-Stoltzfus, A., & Laurence, J. (2020). Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Translational Research.
Ng, J. H., Bijol, V., Sparks, M. A., Sise, M. E., Izzedine, H., & Jhaveri, K. D. (2020). Pathophysiology of Acute Kidney Injury in Patients with COVID-19. Advances in Chronic Kidney Disease, 27(5).
Pereira, A. S. et al. Metodologia da pesquisa científica [recurso eletrônico]- Santa Maria, RS: UFSM, NTE, 2018.
Polito, M. G., & Kirsztajn, G. M. (2010). Microangiopatias trombóticas: púrpura trombocitopênica trombótica e síndrome hemolítico-urêmica. Jornal Brasileiro de Nefrologia, 32(3), 303–315.
Song, W.-C., & FitzGerald, G. A. (2020). COVID-19, microangiopathy, hemostatic activation, and complement. Journal of Clinical Investigation.
Tiwari, N. R., Phatak, S., Sharma, V. R., & Agarwal, S. K. (2021). COVID-19 and thrombotic microangiopathies. Thrombosis Research, 202, 191–198.
Wang, X., Sahu, K. K., & Cerny, J. (2020). Coagulopathy, endothelial dysfunction, thrombotic microangiopathy and complement activation: potential role of complement system inhibition in COVID-19. Journal of Thrombosis and Thrombolysis.
Zhang, Y., Xiao, M., Zhang, S., Xia, P., Cao, W., Jiang, W., Chen, H., Ding, X., Zhao, H., Zhang, H., Wang, C., Zhao, J., Sun, X., Tian, R., Wu, W., Wu, D., Ma, J., Chen, Y., Zhang, D., & Xie, J. (2020). Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. New England Journal of Medicine, 382(17), e38.
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