title: Indicators of acute and persistent renal damage in adult thrombotic microangiopathy.
abstract: BACKGROUND
  Thrombotic microangiopathies (TMA) in adults such as thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are life-threatening disorders if untreated. Clinical presentation is highly variable and prognostic factors for clinical course and outcome are not well established.
  
  
  METHODS
  We performed a retrospective observational study of 62 patients with TMA, 22 males and 40 females aged 16 to 76 years, treated with plasma exchange at one center to identify clinical risk factors for the development of renal insufficiency.
  
  
  RESULTS
  On admission, 39 of 62 patients (63%) had acute renal failure (ARF) with 32 patients (52%) requiring dialysis treatment. High systolic arterial pressure (SAP, p = 0.009) or mean arterial pressure (MAP, p = 0.027) on admission was associated with acute renal failure. Patients with SAP>140 mmHg on admission had a sevenfold increased risk of severe kidney disease (OR 7.464, CI 2.097-26.565). MAP>100 mmHg indicated a fourfold increased risk for acute renal failure (OR 4.261, CI 1.400-12.972). High SAP, diastolic arterial pressure (DAP), and MAP on admission were also independent risk factors for persistent renal insufficiency with the strongest correlation for high MAP. Moreover, a high C-reactive protein (CRP) level on admission correlated with renal failure in the course of the disease (p = 0.003). At discharge, renal function in 11 of 39 patients (28%) had fully recovered, 14 patients (23%) remained on dialysis, and 14 patients (23%) had non-dialysis-dependent chronic kidney disease. Seven patients (11%) died. We identified an older age as risk factor for death.
  
  
  CONCLUSIONS
  High blood pressure as well as high CRP serum levels on admission are associated with renal insufficiency in TMA. High blood pressure on admission is also a strong predictor of sustained renal insufficiency. Thus, adult TMA patients with high blood pressure may require special attention to prevent persistent renal failure.
authors.affiliation: Department of Nephrology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Firuseh
authors.initials: F
authors.lastname: Dierkes
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Andriopoulos
authors.forename: Christoph
authors.initials: C
authors.lastname: Sucker
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kuhr
authors.forename: Markus
authors.initials: M
authors.lastname: Hollenbeck
authors.forename: Gerd R
authors.initials: GR
authors.lastname: Hetzel
authors.forename: Volker
authors.initials: V
authors.lastname: Burst
authors.forename: Sven
authors.initials: S
authors.lastname: Teschner
authors.forename: Lars C
authors.initials: LC
authors.lastname: Rump
authors.forename: Thomas
authors.initials: T
authors.lastname: Benzing
authors.forename: Bernd
authors.initials: B
authors.lastname: Grabensee
authors.forename: Christine E
authors.initials: CE
authors.lastname: Kurschat
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D057049:Thrombotic Microangiopathies / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D055815:Young Adult
chemical_list: D015415:Biomarkers