Systemic autoimmune disorders associated with thrombotic microangiopathy: A cross-sectional analysis from the French National TMA registry: Systemic autoimmune disease-associated TMA

Eur J Intern Med. 2021 Nov;93:78-86. doi: 10.1016/j.ejim.2021.05.040. Epub 2021 Jun 24.

Abstract

Context: The management of systemic auto-immune diseases (SAID) -associated thrombotic microangiopathies (TMA) [SAID-TMA] remains debated.

Objectives: To provide a demographic, clinical and therapeutic picture of SAID-TMA.

Methods: A cross-sectional analysis was conducted on adult patients presenting with SAID and TMA from the French National TMA Registry over a 20-year period. Clinical features were extracted and compared to those from a historical cohort of atypical haemolytic and uremic syndrome (aHUS) patients.

Results: Forty-one patients with SAID-TMA were compared to 78 patients with aHUS from a historical cohort. Connective tissue diseases (CTD) were systemic lupus erythematosus (n=18), primary Sjögren's syndrome (n=7), systemic sclerosis (n=11), mixed CTD (n=2) and 2 cases of vasculitides, including 7 overlapping forms and 8 cases of primary antiphospholipid syndromes (APLS). Patients with SAID-TMA generally had pre-existing chronic kidney failure (OR= 3.17, 95%CI: 1.204 to 7.923; p= 0.016) compared to aHUS patients, though creatinine levels were significantly lower (216 [IQR, 108-334] µmol/L vs. 368 [IQR, 170-722] µmol/L; p= 0.002). Patients were less likely to recover if renal replacement therapy was needed at onset (OR= 0.07; 0.02 to 0.34; p <0.0005). Two patients died. Thirty patients responded to immunosuppressive treatment and complete remission was achieved in 25 cases. By contrast, therapeutic plasma exchange (TPE) did not have an early effect on TMA features at Day-7 nor Day-15 (p >0.05).

Conclusion: The management of SAID-TMA implies an early initiation of immunosuppressive drugs for flares of the associated SAID, whereas TPE seem ineffective. KEY MESSAGES.

Keywords: Autoimmune disease; Connective tissue disease; Haemolytic uremic syndrome; Systemic lupus; Systemic sclerosis; Thrombotic microangiopathy.

MeSH terms

  • Adult
  • Antiphospholipid Syndrome* / complications
  • Antiphospholipid Syndrome* / epidemiology
  • Cross-Sectional Studies
  • Humans
  • Lupus Erythematosus, Systemic*
  • Registries
  • Thrombotic Microangiopathies* / epidemiology