Atypical hemolytic-uremic syndrome

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Background

Pathophysiology

  • Congenital defect leading to dysregulation of the alternative complement pathway, which leads to increased complement activity

Diagnosis

  • Genetic mutation analysis of complement regulatory proteins (CFH, CFI, MCP, C3, CFB, THBD) and anti-CFH antibodies

Management

  • Often unable to distinguish from TTP, so plasma exchange should be initiated promptly
  • If no improvement on PLEX and there is significant renal involvement, consider an aHUS-specific treatment
    • Eculizumab to inhibit complement, ideally with full meningococcal vaccination beforehand