Spectrum and outcomes of thrombotic microangiopathies in nephrology: a 17-year cohort from a North African center.

BACKGROUND

Thrombotic microangiopathies (TMA) are rare but life-threatening conditions characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury. They are encountered in nephrology due to their renal manifestations. Data from North African populations remain scarce.

METHODS

We conducted a retrospective observational study over 17 years (2006–2023) in a nephrology department in Tunisia. We included 36 patients with confirmed TMA based on clinical and/or histological criteria. We analyzed demographics, clinical presentations, laboratory findings, renal histology, etiologies, treatments, and outcomes.

RESULTS

The mean age was 35.6 ± 11.3 years, and 55.6% were female. Hypertension was present in 83.3% of cases, and neurological symptoms in 66.7%. Acute kidney injury occurred in 80.6%, with stage 3 KDIGO in most cases. Etiologies were dominated by malignant hypertension (33.3%), pregnancy-related TMA (30.6%), drug-induced TMA (13.9%), and less commonly autoimmune, infectious, or atypical/typical hemolytic uremic syndromes. Renal biopsy, performed in 12 cases, revealed acute and chronic TMA lesions. Treatments included antihypertensive therapy (86.1%), plasma exchange (16.7%), corticosteroids (22.2%), and rituximab (2.7%). No patient received eculizumab. Renal recovery varied widely by etiology, with complete recovery in 90.9% of pregnancy-related cases and none in malignant hypertension. The overall rate of adverse outcomes (death or end stage renal disease (ESRD)) was 58.3%.

CONCLUSION

TMA is a heterogeneous condition with diverse etiologies and outcomes. Early etiological identification and tailored management are crucial to improving renal prognosis, particularly in resource-limited settings where access to targeted therapies is restricted. CLINICAL TRIAL NUMBER: Not applicable.