We are looking after a 29 year-old man with history of hypertension. Presents with severe hypertension, anuric renal failure with creatinine 1200 umol/L and severe pulmonaryhaemorrhage.
His ANCA, anti-GBM, C3, C4, ANA and rhematoid factor are all normal. ADAM-TS activity 55%. Cryglobulins are pending.
Preliminary renal biopsy shows TMA.
He has received has 5 sessions of PLEX, plus 3 pulses of corticosteroids with no response to date.
Can you suggest what you might do at this point?
Dr. Jordan Weinstein