Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA.
Nephrology (Carlton). 2024 Aug;29(8):519-527. doi: 10.1111/nep.14304. Epub 2024 Apr 11.
INTRODUCTION: Atypical haemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) associated with complement dysregulation; aHUS may be associated with other 'triggers' or 'clinical conditions'. This study aimed to characterize this patient population using data from the Global aHUS Registry, the largest collection of real-world data on patients with aHUS. METHODS: Patients enrolled in the Global aHUS Registry between April 2012 and June 2021 and with recorded aHUS-associated triggers or clinical conditions prior/up to aHUS onset were analysed. aHUS was diagnosed by the treating physician. Data were classified by age at onset of aHUS (< or ≥18 years) and additionally by the presence/absence of identified pathogenic complement genetic variant(s) and/or anti-complement factor H (CFH) antibodies. Genetically/immunologically untested patients were excluded. RESULTS: 1947 patients were enrolled in the Global aHUS Registry by June 2021, and 349 (17.9%) met inclusion criteria. 307/349 patients (88.0%) had a single associated trigger or clinical condition and were included in the primary analysis. Malignancy was most common (58/307, 18.9%), followed by pregnancy and acute infections (both 53/307, 17.3%). Patients with an associated trigger or clinical condition were generally more likely to be adults at aHUS onset. CONCLUSION: Our analysis suggests that aHUS-associated triggers or clinical conditions may be organized into clinically relevant categories, and their presence does not exclude the concurrent presence of pathogenic complement genetic variants and/or anti-CFH antibodies. Considering a diagnosis of aHUS with associated triggers or clinical conditions in patients presenting with TMA may allow faster and more appropriate treatment.
介绍:非典型溶血尿毒综合征(aHUS)是一种罕见的血栓性微血管病(TMA),与补体失调有关;aHUS 可能与其他“触发因素”或“临床情况”有关。本研究旨在利用全球 aHUS 登记处(最大的 aHUS 患者真实世界数据集合)的数据,对这一患者人群进行特征描述。
方法:2012 年 4 月至 2021 年 6 月期间,在全球 aHUS 登记处登记且在 aHUS 发病前/时记录有 aHUS 相关触发因素或临床情况的患者被纳入研究。aHUS 由治疗医生诊断。根据 aHUS 发病时的年龄(< 18 岁或≥18 岁)和是否存在/不存在已确定的致病性补体遗传变异和/或抗补体因子 H(CFH)抗体进行分类。未进行基因/免疫检测的患者被排除在外。
结果:截至 2021 年 6 月,全球 aHUS 登记处共纳入 1947 例患者,其中 349 例(17.9%)符合纳入标准。307/349 例(88.0%)患者有单一相关触发因素或临床情况,纳入主要分析。恶性肿瘤最常见(58/307,18.9%),其次是妊娠和急性感染(均为 53/307,17.3%)。有相关触发因素或临床情况的患者一般更有可能在 aHUS 发病时为成年人。
结论:我们的分析表明,aHUS 相关的触发因素或临床情况可以分为有临床意义的类别,其存在并不排除同时存在致病性补体遗传变异和/或抗 CFH 抗体。考虑到在 TMA 患者中伴有触发因素或临床情况的 aHUS 诊断,可能会更快地给予更恰当的治疗。
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