Two Patients With History of STEC-HUS, Posttransplant Recurrence and Complement Gene Mutations

Authors

  • M. Alberti,

    1. IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Disease Aldo e Cele Daccò and Centro Anna Maria Astori, Bergamo, Italy
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  • E. Valoti,

    1. IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Disease Aldo e Cele Daccò and Centro Anna Maria Astori, Bergamo, Italy
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  • R. Piras,

    1. IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Disease Aldo e Cele Daccò and Centro Anna Maria Astori, Bergamo, Italy
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  • E. Bresin,

    1. IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Disease Aldo e Cele Daccò and Centro Anna Maria Astori, Bergamo, Italy
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  • M. Galbusera,

    1. IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Disease Aldo e Cele Daccò and Centro Anna Maria Astori, Bergamo, Italy
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  • C. Tripodo,

    1. Department of Health Science, Human Pathology Section, Tumor Immunology Unit, University of Palermo, Palermo, Italy
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  • F. Thaiss,

    1. Division of Nephrology and Kidney Transplantation, Department of Internal Medicine, University Hospital UKE, Hamburg, Germany
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  • G. Remuzzi,

    Corresponding author
    1. IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Disease Aldo e Cele Daccò and Centro Anna Maria Astori, Bergamo, Italy
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  • M. Noris

    1. IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Disease Aldo e Cele Daccò and Centro Anna Maria Astori, Bergamo, Italy
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Abstract

Hemolytic uremic syndrome (HUS) is a disease of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. About 90% of cases are secondary to infections by Escherichia coli strains producing Shiga-like toxins (STEC-HUS), while 10% are associated with mutations in genes encoding proteins of complement system (aHUS). We describe two patients with a clinical history of STEC-HUS, who developed end-stage renal disease (ESRD) soon after disease onset. They received a kidney transplant but lost the graft for HUS recurrence, a complication more commonly observed in aHUS. Before planning a second renal transplantation, the two patients underwent genetic screening for aHUS-associated mutations that revealed the presence of a heterozygous CFI mutation in patient #1 and a heterozygous MCP mutation in patient #2, and also in her mother who donated the kidney. This finding argues that the two cases originally diagnosed as STEC-HUS had indeed aHUS triggered by STEC infection on a genetic background of impaired complement regulation. Complement gene sequencing should be performed before kidney transplantation in patients who developed ESRD following STEC-HUS since they may be undiagnosed cases of aHUS, at risk of posttransplant recurrence. Furthermore, genetic analysis of donors is mandatory before living-related transplantation to exclude carriers of HUS-predisposing mutations.

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