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Year : 2014  |  Volume : 24  |  Issue : 1  |  Page : 24-27

Thrombotic microangiopathy in renal allografts

1 Consultant, Department of Pathology, Aware Global Hospitals, Visakhapatnam, India
2 Department of Nephrology, Aware Global Hospitals, Consultant, Visakhapatnam, India
3 Consultant, Department of Nephrologist, Hyderabad Kidney and Laparoscopic Centre, Visakhapatnam, India
4 Professor of Nephrology, Andhra Medical College and King George Hospital, Visakhapatnam, India
5 Consultant Nephrologist, Kamineni Hospitals, Hyderabad, India

Correspondence Address:
S Radha
Plot No. 20, Road No. 1, Alakapuri, Hyderabad - 500 035
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-4065.125052

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Thrombotic microangiopathy (TMA) is a serious complication of renal transplantation. It is a morphological expression of various etiological factors. In a renal allograft, TMA can occur de novo or be a recurrent disease. The aim of this study was to analyze the etiological factors and observe the changing trends of TMA with respect to emerging new etiological factors. We evaluated 131 graft biopsies over a period of 2½ years (2010-2012). All the renal biopsies were formalin fixed, paraffin embedded. Twenty serial sections were studied. Stains routinely used were Hematoxylin and Eosin, Periodic Acid Schiff, Massons Trichrome and Silver Methenamine stains. C4d by immunohistochemical method was done on all graft biopsies. Incidence of TMA in our series was 9.1%. Out of the 12 cases, five were associated with calcineurin inhibitor toxicity, three were diagnosed as acute antibody-mediated rejection, and two were recurrent haemolytic uremic syndrome. One patient developed haemolytic uremic syndrome on treatment with sirolimus and one patient was cytomegalovirus positive on treatment with ganciclovir, developed haemolytic uremic syndrome during treatment course. This study describes a spectrum of etiological factors for thrombotic mciroangiopathy ranging from common cause like calcineurin inhibitor toxicity to rare cause like ganciclovir induced TMA.


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Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07