A 32-year-old woman with SLE presents with new-onset hypertension, rising creatinine, thrombocytopenia, and microangiopathic haemolytic anaemia. Anti-dsDNA titres are elevated and complement is low. Which diagnosis BEST explains this picture?

• A Lupus nephritis class III
• B Thrombotic thrombocytopenic purpura (TTP)
• C Haemolytic uraemic syndrome due to E. coli O157:H7
• D Lupus-associated thrombotic microangiopathy (TMA) ✓

Explanation

Lupus-associated thrombotic microangiopathy (TMA) presents with MAHA, thrombocytopenia, and renal impairment in the setting of active SLE (high anti-dsDNA, low complement), distinguishing it from classical TTP (low ADAMTS13, usually not autoimmune-driven by lupus) and HUS (Shiga-toxin associated, usually GI prodrome). While lupus nephritis can cause renal disease, the MAHA and thrombocytopenia together with active serological disease point to TMA as the dominant process. Plasma exchange plus immunosuppression targeting the SLE is the therapeutic approach.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.