Abstract:

Abstract Objective: Thrombotic microangiopathy (TMA) is a pathologic lesion and predicts a worse prognosis in kidney. Microangiopathic hemolytic anemia and thrombocytopenia are often suggestive of this lesion, but the standard diagnostic test is still a renal biopsy. The objective of this study is to develop a noninvasive panel and validate its value of diagnosing TMA. Methodology: Two hundred twenty suspected patients were divided into TMA group (n=51) and non-TMA group (n=169) according to renal biopsy results. They were used to develop a diagnostic panel of TMA by binary logistic gression. The internal validation were then performed, including 46 independent patients and 157 patients with systemic lupus erythematosus (SLE) and the diagnostic value for TMA lesion was further evaluated. Results: The patients with TMA presented worse renal outcome after 12 months of follow-up (P=0.015), compared with those without TMA. A panel of 4 variables - levels of serum creatinine, platelets, LDH and ADAMTS13 activity discriminated between patients with TMA and those without (area under the curve [AUC], 0.800; 95% confidence interval [CI], 0.723 to 0.877; P<0.001): logitP= -0.371-0.002×ADAMTS13activity+0.140×SCr+0.004×LDH-0.010×PLT. This panel was internally validated in 46 independent patients (AUC, 0.815; P<0.001). The Hosmer-Lemeshow test indicated a good fit (P=0.489). In the set of suspected patients with SLE , the AUCs were 0.852 (P<0.001). Conclusions: A validated panel including serum creatinine, platelets, LDH and ADAMTS13 activity may be one of noninvasive utility in informing clinicians TMA diagnosis and and patients.

Key words: TMA,  noninvasive,  diagnosis