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2.1
Microangiopathy
Disease of Capillaries

Presentation

She presented high blood pressure, decreased urine output (with no macroscopic changes), and impaired renal function. [revistanefrologia.com]

A diagnostic and therapeutic approach is presented, based on international guidelines, disease registries and published trials. [ncbi.nlm.nih.gov]

In summary, we present a woman with the clinical and pathological features of Susac’s syndrome. [jnnp.bmj.com]

A diagnostic algorithm for the investigation and management of a patient presenting with thrombotic microangiopathy. Supportive treatment is essential. [cjasn.asnjournals.org]

Entire Body System

  • Anemia

    Radiological improvement was seen, but altered renal function, anemia and LDH of 847 U/l persisted. [archbronconeumol.org]

    Major finding: Extended-release oxymorphone hydrochloride (Opana ER) tablets contain an inert ingredient that can trigger acute microangiopathic hemolytic anemia and thrombocytopenia in those who abuse the drug via intravenous injection. [mdedge.com]

    Los casos descritos representan las principales condiciones asociadas a lupus que pueden generar anemia microangiopática, como son: anemia hemolítica microangiopática, síndrome antifosfolípido con microangiopatía localizada y síndrome antifosfolípido [revistas.udea.edu.co]

    The causes of the anemia can be multifactorial; iron and/or folate deficiency, hemorrhage, and marrow involvement due to infiltrative processes can contribute to the anemia. [medtextfree.wordpress.com]

    The typical clinical presentation is microangiopathic hemolytic anemia accompanied by thrombocytopenia with varying degrees of organ ischemia. [mayoclinicproceedings.org]

  • Falling

    This type of brain tissue helps you think fast, walk straight, and keeps you from falling. When it becomes diseased, the myelin breaks down. The signals that help you do these things can’t get through. [webmd.com]

    Anemia and thrombocytopenia were primary considered to be consistent with ATG myelotoxicity (fall in hemoglobin 9.3-6.2 g/l; fall in platelet count 254-76 x 10 9/l). [czytelniamedyczna.pl]

    This led to a progressive fall in LDH, platelets normalized and creatinine levels fell to 1.35 mg/dl within 1 week ( Table 1 ). Hemoglobin stabilized at 11.0 g/dl. [archbronconeumol.org]

    differential diagnosis includes complement-mediated aHUS, TTP, and HELLP TTP: 10%–36% of women with TTP present during pregnancy (44) vWf increases in normal pregnancy and consumes ADAMTS13; in women with a genetic predisposition, its activity can fall [cjasn.asnjournals.org]

    Extrapyramidal symptoms [12, 13, 14], gait disturbance [15,16], falls [13,16] and bladder incontinence [16] are reputed to be clinical features of brain leukoariosis. [emvmsa1a.jouve-hdi.com]

  • Asymptomatic

    Biological signatures of asymptomatic extra- and intracranial atherosclerosis: the Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) study. Stroke. 2012; 43: 2712-2719 Arenillas J.F. Alvarez-Sabin J. Molina C.A. et al. [atherosclerosis-journal.com]

    Screening for Hepatitis C | CTFPHC Review Canadian Task Force on Preventive Health Care guideline on Hepatitis C screening REFERENCE BOOK Screening for Abdominal Aortic Aneurysm | CTFPHC REFERENCE BOOK Impaired Vision | CTFPHC REFERENCE BOOK Screening for Asymptomatic [qxmd.com]

    Macular microangiopathy in sickle cell disease using optical coherence tomography angiography Purpose To characterize the optical coherence tomography angiography (OCTA) appearance of the perifoveal macular microvasculature in visually asymptomatic patients [octnews.org]

    • New born / Elderly • Hereditary / Acquired • Asymptomatic / Lethal • Renal/CNS/GI/Skin/Pancreas • Acute/recurring/chronic • Amenable / Treatment resistant 12. [slideshare.net]

    Sporadic CAA Cerebral amyloid angiopathy is a frequent incidental finding, found on screening gradient-recalled echo imaging in up to 16% of asymptomatic elderly patients 4. [radiopaedia.org]

Cardiovascular

  • Hypertension

    The onset of hypertension or poorly controlled blood pressure has been previously described in patients undergoing INFB treatment, with the FDA describing 19 cases of hypertension out of 12,700 patients treated with INFB. [revistanefrologia.com]

    Hypertensive microangiopathy, also referred to as chronic hypertensive encephalopathy (not to be confused with acute hypertensive encephalopathy, better known as PRES) results from the sustained effects of elevated systemic blood pressure on the brain [radiopaedia.org]

    A total of 45.1% patients in the group had hypertension with WMHs and 28.1% patients had hypertension without WMHs (P=.006). [onlinelibrary.wiley.com]

    According to the Framingham study, LVH develops in 15-20% of patients with mild arterial hypertension, and in 50% of patients with severe hypertension. [anatoljcardiol.com]

  • Thrombosis

    DIC subcommittee of the Japanese Society on Thrombosis and Hemostasis: Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thromb J. 2016;14:42. 38. [thrombosisjournal.biomedcentral.com]

    About TMA Thrombotic microangiopathies (TMA) are a category of diseases linked by endothelial injury leading to aggregation of platelets on the damaged endothelium, microvascular thrombosis and organ dysfunction related to microvascular injury. [cincinnatichildrens.org]

    She was started on intravenous heparin and then oral warfarin, which she continues to take now 6 months after her deep vein thrombosis. [jnnp.bmj.com]

    In conclusion, this study revealed the association of microangiopathy, thrombosis and inflammatory infiltrates with nerve degeneration in diabetic nerves, demonstrating that CD40 is a key molecule for the upregulation of HIF-1α and PTEN underlying the [ncbi.nlm.nih.gov]

  • Vascular Disease

    […] insufficiency Peripheral vascular disease Peripheral vascular disease w pain at rest Peripheral vascular disease, rest pain Posterior tibial artery insufficiency Secondary peripheral vascular disease Tissue necrosis in peripheral vascular disease Tissue [icd9data.com]

    Type 2 diabetes induces microangiopathy such as retinopathy, nephropathy and neuropathy and also macroangiopathy such as cardio- and cerebro-vascular diseases and peripheral artery disease (PAD). [internationaljournalofcardiology.com]

    Of interest chiefly to specialists in diabetes mellitus and in vascular disease. FULL TEXT [annals.org]

    […] system and connective tissue M30-M36 2019 ICD-10-CM Range M30-M36 Systemic connective tissue disorders Includes autoimmune disease NOS collagen (vascular) disease NOS systemic autoimmune disease systemic collagen (vascular) disease Type 1 Excludes autoimmune [icd10data.com]

Skin

  • Purpura

    D69.2 ICD-10-CM Diagnosis Code D69.2 Other nonthrombocytopenic purpura 2016 2017 2018 2019 Billable/Specific Code Applicable To Purpura NOS Purpura simplex Senile purpura thrombocytopenic D69.49 ICD-10-CM Diagnosis Code D69.49 Other primary thrombocytopenia [icd10data.com]

    Multidisciplinary approach in pregnancy-associated thrombotic thrombocytopenic purpura: a case report. Blood transfusion = Trasfusione del sangue. 2014;12 Suppl 1:s137-40. 5. [mds.marshall.edu]

    Thrombotic thrombocytopenic purpura. Medicina Universitaria, 17 (2015), pp. 234-239 [3] A.S. Farzana, C. Abrams. How I treat refractory thromboctic thrombocytopenic purpura. Blood, 125 (2015), pp. 3860-3867 [4] J. George. [elsevier.es]

    Thrombotic thrombocytopenic purpura related to ticlopidine. Lancet 1991; 337: 774–6 PubMed CrossRef Google Scholar 88. Leavey SF, Weinberg J. Thrombotic thrombocytopenic purpura associated with ticlopidine therapy. [link.springer.com]

  • Sweating

    In all three cases, however, histological examinations revealed a more or less reduced, atrophic dermis with here and there an appreciable dislocation of the subcutaneous layer of fat, which with the sweat glands formed an intracutaneous herniation up [onlinelibrary.wiley.com]

    Occasionally patients complain of over-sweating elsewhere, a compensatory mechanism for loss of the ability to temperature regulate in the involved area. [telemedicine.org]

    Association of apolipoprotein E epsilon2 with white matter disease but not with microbleeds Stroke 2007 ; 38 : 1185-1188 [cross-ref] [35] Gold S.M., Dziobek I., Sweat V., Tirsi A., Rogers K., Bruehl H., and al. [emvmsa1a.jouve-hdi.com]

  • Skin Lesion

    Am J Clin Path 50:547-554, 1968. (38)Melin H: An atrophic circumscribed skin lesion in the lower extremities of diabetics. [telemedicine.org]

    Four cases presented necrotic lesions, while 3 patients complained of severe Raynaud phenomenon. Three of the previously published cases also developed peripheral skin lesions ( 25,39,59 ). [journals.lww.com]

    Chronic changes were mucoid changes and onion skin lesions of arterioles and/or arteries (Additional file 2, Figure S2C). [arthritis-research.biomedcentral.com]

  • Skin Disease

    DIABETES IN SKIN DISEASE Art Huntley, M.D. Rhett Drugge, M.D. ABSTRACT Diabetes mellitus is a common condition which frequently has skin manifestations. [telemedicine.org]

Face, Head & Neck

  • Epistaxis

    Creatinine levels deteriorated, falling to 3.92 mg/dl (0.73 mg/dl on admission), hematocrit fell to 22.6% and thrombocytopenia to 18 000/μl, causing repeated epistaxis. [archbronconeumol.org]

Neurologic

  • Polyneuropathy

    Dyck PJ, Yasuda H, Karnes J, Lais A, Service FJ (1985) Ischemia in the etiology of diabetic polyneuropathy. J Neuropathol Exp Neurol 44:346 [Abstr] Google Scholar 11. [link.springer.com]

    更多 Diabetic sensorimotor polyneuropathy (DSP) remains the most common microvascular complication of both type 1 and type 2 diabetes, and poses a unique set of management challenges in the prevention of foot complications. [dict.cnki.net]

    Diabetes is a major cause of microangiopathy, related to hyperglycaemia and hypertension, and leads to renal insufficiency, retinal damage and polyneuropathy. [emvmsa1a.jouve-hdi.com]

Workup

The differential diagnoses are generally broad, while the workup is frequently complex and can be confusing. [mayoclinicproceedings.org]

The lack of early response to plasma exchange prompted extensive laboratory workup. Ultimately, the patient completely recovered with negative fluid balance and control of severe hypertension. [bmcnephrol.biomedcentral.com]

Clinical Workup The clinical measures examined were blood chemistry, cardiovascular assessment, clinical tests and physiological recordings. [ncbi.nlm.nih.gov]

Serum

  • Dyslipidemia

    The pathogenic mechanisms involved in the progress of atherosclerosis in these patients are indeed multifactorial; insulin resistance and adipose tissue dysfunction, dysglycemia and advanced glycation end product formation, dyslipidemia, oxidative stress [jamanetwork.com]

    We speculate about the possibility that under dyslipidemias associated with increased exposure of vascular cells to NEFA, like in type 2 diabetes, similar alterations may contribute to associated macrovascular and microvascular complications. [dict.cnki.net]

    Maternal serum dyslipidemia occurs early in pregnancy in women with mild but not severe preeclampsia. Am J Obstet Gynecol 2009;201(3):293.e1-293.e4. Ryu S, Huppmann AR, Sambangi N, Takacs P, Kauma SW. [medigraphic.com]

    […] prevalence of 20% to 25%, regardless of disease stage. 2 The most probable reasons for the difference between types 1 and 2 diabetes in this regard are greater disease heterogeneity, association with risk factors (eg, insulin resistance, metabolic control, dyslipidemia [medicographia.com]

    In addition, diabetes is frequently associated with other known cardiovascular risk factors, including hypertension, obesity, and dyslipidemia. [ncbi.nlm.nih.gov]

  • Decreased Platelet Count

    Laboratory findings suggestive of thrombotic microangiopathy include decreased platelet counts, increased serum lactate dehydrogenase, and schistocytes (red blood cell fragmentation) on a blood film. [gov.uk]

    Disseminated intravascular coagulation is a syndrome characterized by increased PA and APTT, decreased platelet count, and decreased levels of fibrinogen3. Some cases of adult's Still disease associated with this coagulopathy have been described4. [scielo.br]

    The most commonly used criteria were red cell fragmentation, increased lactate dehydrogenase (LDH) concentration, a decrease in platelet count or increased platelet transfusion requirement, renal failure, decreased hemoglobin level or increased red blood [haematologica.org]

    Therefore, elevated FRMs and decreased platelet counts are the most useful markers for DIC [1]. Table 3 Differences and similarities between TMA and DIC Fig. 3 Microvascular thrombosis in DIC and TMA. [thrombosisjournal.biomedcentral.com]

Treatment

Interferon treatment was discontinued and treatment with renin angiotensin system inhibitors was initiated. [revistanefrologia.com]

The review suggested that there may be an association between interferon beta treatment and thrombotic microangiopathy and between interferon beta treatment and nephrotic syndrome. [gov.uk]

Patients can only switch treatment arms once. [clinicaltrials.gov]

Téllez-Hinojosa et al.2 elegantly analyzes classic TM etiopathogenesis, diagnosis and treatment in this issue of Medicina Universitaria. [elsevier.es]

Treatment with ixazomib and lenalidomide was discontinued. Despite these measures, the thrombocytopenia persisted and the renal failure worsened, the patient requiring dialysis after 72 hours. [journals.lww.com]

Prognosis

Research in Respiratory Intensive Care Onco-Hematology) European Respiratory Journal 2016 47: 688-690; DOI: 10.1183/13993003.01276-2015 Abstract Better pathophysiological understanding of PTTM could result in specific targeted therapies and improve prognosis [erj.ersjournals.com]

Microphthalmos with cyst had the worst prognosis, coloboma with microcornea and microphthalmos a poor prognosis, coloboma with only microcornea had an intermediate prognosis, and simple coloboma had the best prognosis. [aao.org]

In post kidney transplantation TMA have a better prognosis, and if limited to the allograft, resolution is reported around to 80%. [kidneypathology.com]

Frequency of microangiopathic hemolytic anemia in patients with systemic lupus erythematosus exacerbation: Distinction from thrombotic thrombocytopenic purpura, prognosis, and outcome. Arthritis Rheum. 2005 Dec;53(6):982-5. (10.) [aprendeenlinea.udea.edu.co]

Etiology

Multiple etiological factors include VASCULAR ENDOTHELIAL CELL damage due to SHIGA TOXIN; FACTOR H deficiency; and aberrant VON WILLEBRAND FACTOR formation. Se även Thrombosis Svenska synonymer Inga svenska synonymer finns. [mesh.kib.ki.se]

There are different pathologies of various etiologies, hereditary or acquired, which causes said microangiopathy. [elsevier.es]

Multiple etiological factors include vascular endothelial cell damage due to shiga toxin; factor h deficiency; and aberrant von willebrand factor formation. [icd10data.com]

[…] absent 1 = “caps” or pencil-thin lining 2 = smooth “halo” 3 = irregular periventricular signal extending into the deep white matter deep white matter (DWM) 0 = absent 1 = punctate foci 2 = beginning confluence 3 = large confluent areas Importantly the etiology [radiopaedia.org]

Epidemiology

George at the Departments of Internal Medicine and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, P.O. Box 26901, Oklahoma City, OK 73126-0901, or at [email protected] . [nejm.org]

SHOWING 1-10 OF 106 REFERENCES Diabetes Mellitus and Its Complications: Molecular Mechanisms, Epidemiology, and Clinical Medicine, The Annals of the New York Academy of Science Volume 1084 (1st edition) Glucose, Advanced Glycation Extraesophageal reflux [semanticscholar.org]

The descriptive epidemiology of anophthalmia and microphthalmia. Int J Epidemiol. 1996;25:1009–1016. ↑ 8.0 8.1 Forrester MB, Merz RD. Descriptive epidemiology of anophthalmia and microphthalmia, Hawaii, 1986–2001. [eyewiki.aao.org]

Pathophysiology

OBJECTIVES: The progression and pathophysiology of neuropathy in impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) is poorly understood, especially in relation to autophagy. [ncbi.nlm.nih.gov]

The pathophysiology of LVH includes hypertrophy of cardiomyocytes, interstitial and perivascular fibrosis, coronary microangiopathy and macroangiopathy. [anatoljcardiol.com]

Vincent for the GrrrOH: Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (Group for Research in Respiratory Intensive Care Onco-Hematology) European Respiratory Journal 2016 47: 688-690; DOI: 10.1183/13993003.01276-2015 Abstract Better pathophysiological [erj.ersjournals.com]

The current classification of various syndromes of TMA is heterogeneous and often does not take the underlying pathophysiology into consideration. [academic.oup.com]

There is possible parallel and/or overlap in the pathophysiology of TMA and PRES. [ajnr.org]

Prevention

REFERENCE BOOK Screening for Colorectal Cancer | CTFPHC REFERENCE BOOK Screening for Cognitive Impairment | CTFPHC REFERENCE BOOK Screening for Depression | CTFPHC REFERENCE BOOK Screening for Developmental Delay | CTFPHC Review Canadian Task Force on Preventive [qxmd.com]

To prevent death and serious organ damage TTP requires immediate treatment with plasma exchange (PLEX) – see Figure 5 for a diagram. [unckidneycenter.org]

We also highlight how new insights into pathogenic mechanisms of vascular damage in diabetes may indicate new targets for prevention and treatment. Copyright © 2017 Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]

The offending agent suspected of causing the TMA should be promptly discontinued to prevent further progression of injury. If the offending agent needs to be redosed, caution should be taken to re-introduce the drug at a lower dose. [ajkdblog.org]

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