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Complement-mediated thrombotic microangiopathy associated with lupus nephritis.

Mi Hee Park1, Nicholas Caselman1, Scott Ulmer2

  • 1Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Blood Advances
|August 23, 2018
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Summary

Complement-mediated thrombotic microangiopathy (CM-TMA) in lupus nephritis (LN) patients can mimic atypical hemolytic uremic syndrome (aHUS). Complement inhibition effectively treated 10 of 11 LN patients with CM-TMA, suggesting a distinct clinical entity.

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Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Background:

  • Complement-mediated thrombotic microangiopathy (CM-TMA) is a serious condition involving excessive complement activation, leading to thrombocytopenia, hemolytic anemia, and organ damage.
  • A subset of lupus nephritis (LN) patients develop thrombotic microangiopathy (TMA) with features similar to atypical hemolytic uremic syndrome (aHUS), often resistant to standard treatments.

Purpose of the Study:

  • To investigate the efficacy of complement inhibition in lupus nephritis patients presenting with thrombotic microangiopathy (TMA).
  • To characterize a distinct subset of lupus patients with CM-TMA and explore potential underlying genetic factors.

Main Methods:

  • Retrospective analysis of 11 lupus nephritis patients with thrombotic microangiopathy (TMA) who were treated with complement inhibition.
  • Genetic analysis for mutations in complement regulatory proteins in a subset of patients.

Main Results:

  • Ten of the 11 patients with lupus nephritis and CM-TMA achieved successful treatment outcomes with complement inhibition.
  • Complement-regulatory protein mutations were identified in 6 of 10 tested patients, including CFH, factor I, and others.
  • One patient experienced renal allograft loss, and three had concurrent antiphospholipid syndrome.

Conclusions:

  • Complement inhibition represents a highly effective therapeutic strategy for lupus nephritis patients with thrombotic microangiopathy (TMA).
  • This specific patient group exhibits clinical and pathological characteristics consistent with atypical hemolytic uremic syndrome (aHUS), suggesting a distinct entity: CM-TMA associated with LN.