Affiliation:
1. Rostov State Medical University
2. Regional Clinical Hospital No. 2
Abstract
The article considers a clinical case of atypical hemolytic-uremic syndrome, which was the starting mechanism for the development of membranous nephropathy. Patient X. 23 years after acute respiratory viral infection, signs of nephrotic syndrome, arterial hypertension, and impaired kidney function appeared. Puncture nephrobiopsy was performed and the morphological picture corresponds to immunocomplex glomerulonephritis, most likely membranous nephropathy with the presence of segmental glomerulosclerosis, cellular half-moons. In parallel, the patient had verified signs of thrombotic microangiopathy in the form of microangiopathic anemia, thrombocytopenia, increased lactate dehydrogenase levels as a sign of cytolysis (primarily intravascular hemolysis). During the differential diagnosis, we stopped at the diagnosis of atypical hemolytic-uremic syndrome. The uniqueness of the described clinical case is that cases of glomerulonephritis against the background of atypical hemolytic-uremic syndrome are extremely rare, and membranous nephropathy is described for the first time.
Publisher
Rostov State Medical University
Reference16 articles.
1. Yerigeri K, Kadatane S, Mongan K, Boyer O, Burke LLG, Sethi SK, et al. Atypical Hemolytic-Uremic Syndrome: Genetic Basis, Clinical Manifestations, and a Multidisciplinary Approach to Management. J Multidiscip Healthc. 2023;16:2233-2249. DOI: 10.2147/JMDH.S245620
2. Козловская Н.Л., Коротчаева Ю.В., Демьянова К.А., Шифман Е.М. Сравнительная характеристика акушерского и «общепопуляционного» атипичного гемолитико-уремического синдрома у взрослых. Нефрология и диализ. 2022;24(1):52-61. DOI: 10.28996/2618-9801-2022-1-52-61
3. Козловская Н.Л. Атипичный гемолитико-уремический синдром: современные представления о патогенезе, клинике, подходах к диагностике и лечению. Тромбоз, гемостаз и реология. 2019;4(8):13-20. DOI: 10.25555/THR.2019.4.0895
4. Tiwari V, Bhandari G, Gupta A, Gupta P, Bhargava V, Malik M, et al. Atypical HUS Triggered by COVID-19: A Case Report. Indian J Nephrol. 2022;32(4):367-370. DOI: 10.4103/ijn.ijn_196_21
5. Manickam N, Agrawal V, Prasad P, Jain M, Prasad N. Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study. Turk Patoloji Derg. 2022;38(1):1-8. DOI: 10.5146/tjpath.2021.01536