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PATHOLOGY OF THROMBOTIC MICROANGIOPATHY Terry Cook Imperial College London KDIGO

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Page 1: PATHOLOGY MICROANGIOPATHY KDIGO OF THROMBOTICTMA due to malignant hypertension • Can C5b-9 staining help? 3. What is the distinction between TMA associated with malignant hypertension

PATHOLOGY OF THROMBOTIC MICROANGIOPATHY

Terry Cook Imperial College London

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

Disclosure of Interests

•  GlaxoSmithKline - consultancy

•  Biogen Idec - consultancy

•  Achillion Pharmaceuticals - consultancy

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

TMA - morphology

Range of morphological changes in the kidney vasculature in response to endothelial injury

May involve glomeruli, arterioles and arteries

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

Glomeruli – acute lesions

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

Glomeruli – acute lesions

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

Glomeruli- chronic lesions

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

Glomeruli- chronic lesions

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

Arterioles

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

Arteries

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

•  1. Nomenclature of TMA: is it a problem that TMA encompasses changes that are not 'thrombotic' (e.g., glomerular subendothelial expansion, mesangiolysis and myxoid arterial intimal thickening)? KDIGO

Page 11: PATHOLOGY MICROANGIOPATHY KDIGO OF THROMBOTICTMA due to malignant hypertension • Can C5b-9 staining help? 3. What is the distinction between TMA associated with malignant hypertension

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

•  2. What are the morphological differences between TMAs of different etiology?

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

•  Shiga toxin associated HUS shows only glomerular involvement

•  TTP has platelet rich thrombi •  TMA due to malignant hypertension shows

predominant vascular involvement •  Does C5b-9 staining differentiate causes

due to primary complement activation?

2. What are the morphological differences between TMAs of different etiology?

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

•  3. What is the distinction between TMA associated with malignant hypertension as opposed to TMA due to other causes with secondary hypertension?

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

•  Possibly more chronic vascular changes in TMA due to malignant hypertension

•  Can C5b-9 staining help?

3. What is the distinction between TMA associated with malignant hypertension as opposed to TMA due to other

causes with secondary hypertension?

KDIGO

KDIGO Controversies Conference on Complement-Mediated Kidney Diseases November 19-21. 2015 | Barcelona, Spain

•  4. What are the morphological features of acute and chronic TMA lesions?

•  Is there an entity of chronic TMA due to complement abnormalities that leads to chronic renal impairment without acute episodes? KDIGO

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