Figure 3
The upper part of figure 3 summarizes the concept of Timmermans et al.. Measurement of exvivo formation of C5b-9 on endothelial cells and genetic screening can divide patients with hypertensive emergency and thrombotic microangiopathy into high blood pressure or complement mediated thrombotic microangiopathy. Malignant nephrosclerosis and aHUS are two diseases with an overlap as shown in the lower part. On the left hand, malignant nephrosclerosis driven primarily by high blood pressure and on the right hand aHUS driven by complement dysfunction. In between lies a continuum with increasing or decreasing importance of complement dysfunction and blood pressure. Histology shows onion-like narrowing of intrarenal vessels and ischemic glomeruli in malignant nephrosclerosis. In case of aHUS, fresh vascular and glomerular fibrin thrombi (arrows) are found as well as HUS glomerulopathy. Figure 3 modified from Timmermans et al. 2020 and van Laecke et al. 2017. MG=masson goldner staining. Histology pictures are kindly provided by T. Wiech, Hamburg, Germany.