Case series of secondary thrombotic microangiopathy in children with multisystem inflammatory syndrome associated with COVID-19
Thrombotic microangiopathy (TMA) is one of the main links in the pathogenesis of multisystem inflammatory syndrome in children (MIS-C) associated with a new coronavirus infection caused by SARS-Cov-2 (COVID-19). In the setting of an increasing number of patients with hemolytic uremic syndrome (HUS) during the COVID-19 pandemic, 5 out of 7 cases of HUS (according to the Khimki Regional Hospital) in children revealed the association between acute kidney injury (AKI) and history of COVID-19. Also, there were recorded laboratory markers of systemic inflammation, the relevant criteria for the diagnosis of MIS-C associated with SARS-CoV-2. The article presents a clinical analysis of the case series concerning HUS, during which a comparison with the world literature data was conducted. It was proposed to consider this pathology in children as secondary thrombotic microangiopathy (TMA) in the setting of new coronavirus infection, similar to secondary TMA, developed due to exposure to HIV. During the COVID-19 pandemic, it is extremely important to establish the association between the TMA and the experienced COVID-19 in children for the therapy correction and further follow-up of patients after discharge from the hospital.