» Articles » PMID: 30393246

Pathogenesis of Atypical Hemolytic Uremic Syndrome

Overview
Date 2018 Nov 6
PMID 30393246
Citations 36
Authors
Affiliations
Soon will be listed here.
Abstract

Atypical hemolytic uremic syndrome (aHUS) is a type of thrombotic microangiopathy (TMA) defined by thrombocytopenia, microangiopathic hemolytic anemia, and renal failure. aHUS is caused by uncontrolled complement activation in the alternative pathway (AP). A variety of genetic defects in complement-related factors or acquired autoantibodies to the complement regulators have been found in 50 to 60% of all cases. Recently, however, the classification and diagnosis of aHUS are becoming more complicated. One reason for this is that some factors, which have not been regarded as complement-related factors, have been reported as predisposing factors for phenotypic aHUS. Given that genotype is highly correlated with the phenotype of aHUS, careful analysis of underlying genetic abnormalities or acquired factors is needed to predict the prognosis or to decide an optimal treatment for the disease. Another reason is that complement dysregulation in the AP have also been found in a part of other types of TMA such as transplantation-related TMA and pregnancy-related complication. Based on these findings, it is now time to redefine aHUS according to the genetic or acquired background of abnormalities.Here, we review the pathogeneses and the corresponding phenotypes of aHUS and complement-related TMAs.

Citing Articles

A Case of Atypical Hemolytic Uremic Syndrome With a Complement Factor I Mutation Triggered by a Femoral Neck Fracture.

Kano T, Io H, Sasaki Y, Muto M, Muto S, Ogiwara K Nephrology (Carlton). 2025; 30(3):e70010.

PMID: 40001340 PMC: 11861886. DOI: 10.1111/nep.70010.


The Path to Accessible Care: Development and Impact of Eculizumab Biosimilars for Paroxysmal Nocturnal Hemoglobinuria and Atypical Hemolytic Uremic Syndrome.

Jang J, Han B, Jung J, Russo P, Kulasekararaj A BioDrugs. 2025; 39(2):281-295.

PMID: 39982653 PMC: 11906501. DOI: 10.1007/s40259-025-00707-3.


Atypical hemolytic uremic syndrome with a variant following COVID-19: a case report.

Ando M, Kubota K, Kadowaki S, Kawamoto M, Kawamoto N, Okamoto H Front Pediatr. 2025; 13:1507727.

PMID: 39917338 PMC: 11799235. DOI: 10.3389/fped.2025.1507727.


Severe pregnancy-associated atypical hemolytic uremia syndrome in the context of the COVID-19 pandemic: a novel survival case report.

Yang Y, Li X, Yuan H, Xiong J, Li P, Wang Z BMC Pregnancy Childbirth. 2025; 25(1):93.

PMID: 39885445 PMC: 11780773. DOI: 10.1186/s12884-025-07212-z.


Diacylglycerol Kinases and Its Role in Lipid Metabolism and Related Diseases.

Liu Y, Yang Z, Zhou X, Li Z, Hideki N Int J Mol Sci. 2024; 25(23).

PMID: 39684917 PMC: 11643042. DOI: 10.3390/ijms252313207.


References
1.
Jokiranta T, Hellwage J, Koistinen V, Zipfel P, Meri S . Each of the three binding sites on complement factor H interacts with a distinct site on C3b. J Biol Chem. 2000; 275(36):27657-62. DOI: 10.1074/jbc.M002903200. View

2.
Levy G, Nichols W, Lian E, Foroud T, McClintick J, McGee B . Mutations in a member of the ADAMTS gene family cause thrombotic thrombocytopenic purpura. Nature. 2001; 413(6855):488-94. DOI: 10.1038/35097008. View

3.
Kokame K, Matsumoto M, Soejima K, Yagi H, Ishizashi H, Funato M . Mutations and common polymorphisms in ADAMTS13 gene responsible for von Willebrand factor-cleaving protease activity. Proc Natl Acad Sci U S A. 2002; 99(18):11902-7. PMC: 129366. DOI: 10.1073/pnas.172277399. View

4.
Manuelian T, Hellwage J, Meri S, Caprioli J, Noris M, Heinen S . Mutations in factor H reduce binding affinity to C3b and heparin and surface attachment to endothelial cells in hemolytic uremic syndrome. J Clin Invest. 2003; 111(8):1181-90. PMC: 152934. DOI: 10.1172/JCI16651. View

5.
Sanchez-Corral P, Gonzalez-Rubio C, Rodriguez de Cordoba S, Lopez-Trascasa M . Functional analysis in serum from atypical Hemolytic Uremic Syndrome patients reveals impaired protection of host cells associated with mutations in factor H. Mol Immunol. 2004; 41(1):81-4. DOI: 10.1016/j.molimm.2004.01.003. View