Thrombotic microangiopathies and the kidney

Thrombotic microangiopathies are rare but carry a high morbidity and mortality. Recent research has helped to clarify their aetiology. A high index of suspicion is required in patients presenting with renal impairment and features of microangiopathy such as a low platelet count and Coomb’s test-negative haemolytic anaemia. In Shiga toxin-mediated haemolytic–uraemic syndrome, bacteria such as Escherichia coli O157 and O104 adhere to the intestinal mucosa and secrete a highly potent Shiga cytotoxin that binds to the glomerular endothelium and causes an endotheliopathy.