Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report

Detalhes bibliográficos
Autor(a) principal: Oliveira, Karla Loureto de
Data de Publicação: 2023
Outros Autores: Lima, Rafael Siqueira Athayde, Studart, Rita Mônica Borges
Tipo de documento: Artigo
Idioma: por
Título da fonte: Research, Society and Development
Texto Completo: https://rsdjournal.org/index.php/rsd/article/view/39964
Resumo: 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.
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spelling Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case reportMicroangiopatía trombótica por COVID-19 superpuesta a enfermedad renal crónica no dialitica: reporte de casoMicroangiopatia trombótica por COVID-19 superposta a doença renal crônica não dialítica: relato de casoCOVID-19SARS-CoV-2TrombosisLesión renal aguda.COVID-19SARS-CoV-2TromboseInjúria renal aguda.COVID-19SARS-CoV-2ThrombosisAcute kidney injury.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.Objetivo: Describir un caso de microangiopatía trombótica por COVID-19 sobreañadida a ERC no dialítica, que estaba bajo atención médica por el equipo de enfermería de Nefrología en un centro de referencia en el noreste de Brasil. Metodologia: Estudio de caso clínico en el que presentamos un caso de MAT con daño renal severo desencadenado por SARS-CoV-2 en un paciente con nefropatía crónica previa, que evolucionó con necesidad de hemodiálisis. Resultados: la MAT asociada al SARS-CoV-2 parece estar relacionada con la activación descontrolada de una vía alternativa del complemento y la alteración de la integridad del endotelio vascular, dando lugar a la liberación de citocinas inflamatorias y consecuente activación de la cascada de coagulación local. Para mejorar el resultado de estos pacientes, es necesario identificar rápidamente la MAT, ofrecer terapia de soporte y, cuando corresponda, un tratamiento específico de acuerdo con la fisiopatología subyacente. Discusión: El COVID-19 puede manifestarse como disfunción multiorgánica, siendo la afectación pulmonar la más frecuente. La respuesta inmunitaria exagerada en forma de activación del complemento sin restricciones y tormenta de citoquinas puede ser un factor clave para el daño generalizado de órganos. Puede haber hipercoagulabilidad y una alta tasa de trombosis. Aunque la trombosis macrovascular es común en estos individuos, el hallazgo frecuente de trombosis microvascular plantea la posibilidad de microangiopatía trombótica (TAM) como un factor que contribuye a las complicaciones multiorgánicas, incluido el riñón. Conclusión: El manejo de la MAT es un desafío y las tasas de supervivencia están directamente relacionadas con el tiempo de implementación del tratamiento adecuado.Objetivo: Descrever um caso de microangiopatia trombótica por COVID-19 superposta a DRC não dialítica, que estava sob cuidados médicos da equipe da enfermaria de Nefrologia em um centro de referência no nordeste do Brasil. Metodologia: Estudo do tipo relato de caso no qual apresentamos um caso de MAT com lesão renal grave desencadeada por SARS-CoV-2 em uma paciente com nefropatia crônica prévia, que evoluiu com necessidade de hemodiálise. Resultados: A MAT associada a SARS-CoV-2 parece estar relacionada à ativação descontrolada de uma via alternativa do complemento e à alteração da integridade do endotélio vascular, levando à liberação de citocinas inflamatórias e consequente ativação da cascata de coagulação local. Para melhorar o desfecho desses pacientes, faz-se necessário identificar rapidamente a MAT, ofertar terapia de suporte e, quando aplicável, o tratamento específico de acordo com a fisiopatologia subjacente. Discussão: COVID-19 pode se manifestar como disfunção de múltiplos órgãos, sendo o envolvimento pulmonar o mais comum. A resposta imune exagerada na forma de ativação irrestrita do complemento e tempestade de citocinas podem ser fator chave para a lesão orgânica generalizada. Pode haver hipercoagulabilidade e alta taxa de trombose. Embora a trombose macrovascular seja comum nesses indivíduos, o achado frequente de tromboses microvasculares levanta a possibilidade de microangiopatia trombótica (MAT) como fator contribuinte para as complicações de múltiplos órgãos, incluindo o rim. Conclusão: O manejo da MAT é um desafio e as taxas de sobrevivência estão diretamente relacionadas ao tempo de implementação do tratamento adequado.Research, Society and Development2023-01-23info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://rsdjournal.org/index.php/rsd/article/view/3996410.33448/rsd-v12i2.39964Research, Society and Development; Vol. 12 No. 2; e10412239964Research, Society and Development; Vol. 12 Núm. 2; e10412239964Research, Society and Development; v. 12 n. 2; e104122399642525-3409reponame:Research, Society and Developmentinstname:Universidade Federal de Itajubá (UNIFEI)instacron:UNIFEIporhttps://rsdjournal.org/index.php/rsd/article/view/39964/33413Copyright (c) 2023 Karla Loureto de Oliveira; Rafael Siqueira Athayde Lima; Rita Mônica Borges Studarthttps://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessOliveira, Karla Loureto de Lima, Rafael Siqueira Athayde Studart, Rita Mônica Borges 2023-02-14T20:07:52Zoai:ojs.pkp.sfu.ca:article/39964Revistahttps://rsdjournal.org/index.php/rsd/indexPUBhttps://rsdjournal.org/index.php/rsd/oairsd.articles@gmail.com2525-34092525-3409opendoar:2023-02-14T20:07:52Research, Society and Development - Universidade Federal de Itajubá (UNIFEI)false
dc.title.none.fl_str_mv Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
Microangiopatía trombótica por COVID-19 superpuesta a enfermedad renal crónica no dialitica: reporte de caso
Microangiopatia trombótica por COVID-19 superposta a doença renal crônica não dialítica: relato de caso
title Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
spellingShingle Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
Oliveira, Karla Loureto de
COVID-19
SARS-CoV-2
Trombosis
Lesión renal aguda.
COVID-19
SARS-CoV-2
Trombose
Injúria renal aguda.
COVID-19
SARS-CoV-2
Thrombosis
Acute kidney injury.
title_short Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
title_full Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
title_fullStr Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
title_full_unstemmed Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
title_sort Thrombotic microangiopathy by COVID-19 superposed to non-dialytic chronic kidney disease: case report
author Oliveira, Karla Loureto de
author_facet Oliveira, Karla Loureto de
Lima, Rafael Siqueira Athayde
Studart, Rita Mônica Borges
author_role author
author2 Lima, Rafael Siqueira Athayde
Studart, Rita Mônica Borges
author2_role author
author
dc.contributor.author.fl_str_mv Oliveira, Karla Loureto de
Lima, Rafael Siqueira Athayde
Studart, Rita Mônica Borges
dc.subject.por.fl_str_mv COVID-19
SARS-CoV-2
Trombosis
Lesión renal aguda.
COVID-19
SARS-CoV-2
Trombose
Injúria renal aguda.
COVID-19
SARS-CoV-2
Thrombosis
Acute kidney injury.
topic COVID-19
SARS-CoV-2
Trombosis
Lesión renal aguda.
COVID-19
SARS-CoV-2
Trombose
Injúria renal aguda.
COVID-19
SARS-CoV-2
Thrombosis
Acute kidney injury.
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2023-01-23
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://rsdjournal.org/index.php/rsd/article/view/39964
10.33448/rsd-v12i2.39964
url https://rsdjournal.org/index.php/rsd/article/view/39964
identifier_str_mv 10.33448/rsd-v12i2.39964
dc.language.iso.fl_str_mv por
language por
dc.relation.none.fl_str_mv https://rsdjournal.org/index.php/rsd/article/view/39964/33413
dc.rights.driver.fl_str_mv https://creativecommons.org/licenses/by/4.0
info:eu-repo/semantics/openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/4.0
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Research, Society and Development
publisher.none.fl_str_mv Research, Society and Development
dc.source.none.fl_str_mv Research, Society and Development; Vol. 12 No. 2; e10412239964
Research, Society and Development; Vol. 12 Núm. 2; e10412239964
Research, Society and Development; v. 12 n. 2; e10412239964
2525-3409
reponame:Research, Society and Development
instname:Universidade Federal de Itajubá (UNIFEI)
instacron:UNIFEI
instname_str Universidade Federal de Itajubá (UNIFEI)
instacron_str UNIFEI
institution UNIFEI
reponame_str Research, Society and Development
collection Research, Society and Development
repository.name.fl_str_mv Research, Society and Development - Universidade Federal de Itajubá (UNIFEI)
repository.mail.fl_str_mv rsd.articles@gmail.com
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