{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:45:22Z","timestamp":1790635522318,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T00:00:00Z","timestamp":1714176000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2007957"],"award-info":[{"award-number":["2007957"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2021\/PRE\/0006"],"award-info":[{"award-number":["2021\/PRE\/0006"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ramsay Hospital Research Foundation","award":["2007957"],"award-info":[{"award-number":["2007957"]}]},{"name":"Ramsay Hospital Research Foundation","award":["2021\/PRE\/0006"],"award-info":[{"award-number":["2021\/PRE\/0006"]}]},{"DOI":"10.13039\/501100001782","name":"University of Melbourne","doi-asserted-by":"publisher","award":["2007957"],"award-info":[{"award-number":["2007957"]}],"id":[{"id":"10.13039\/501100001782","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001782","name":"University of Melbourne","doi-asserted-by":"publisher","award":["2021\/PRE\/0006"],"award-info":[{"award-number":["2021\/PRE\/0006"]}],"id":[{"id":"10.13039\/501100001782","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Nephrology"],"published-print":{"date-parts":[[2024,4,27]]},"abstract":"<jats:p>Thrombotic microangiopathy (TMA) reflects a syndrome of endothelial injury characterised by microangiopathic haemolytic anaemia (nonimmune), thrombocytopenia, and often end-organ dysfunction. TMA disorders are well-recognised in kidney transplant recipients, often due to an underlying genetic predisposition related to complement dysregulation, or de novo due to infection, immunosuppression toxicity, or antibody-mediated rejection. In pregnancy, TMA disorders are most commonly due to severe pre-eclampsia or HELLP, but may also be due to thrombotic thrombocytopenic purpura (TTP) or complement-mediated (atypical) haemolytic uremic syndrome (aHUS). Complement dysregulation is being recognised as playing a role in the development of preeclampsia and HELLP syndrome in addition to aHUS. Due to overlapping clinical and laboratory features, diagnosis can be difficult and delays in treatment can be life-threatening for both mother and fetus. This report describes a 32\u2009year-old female who had two successive wanted pregnancies. The first pregnancy was terminated at 22\u2009weeks gestation due to presumed severe preeclampsia and fetal growth restriction in the context of known chronic kidney failure due to reflux nephropathy. A living-related kidney transplant was performed to improve the chances of pregnancy resulting in a live birth. A subsequent pregnancy was complicated by progressive kidney impairment and hypertension at 22\u2009weeks gestation. Kidney biopsy showed TMA, but the etiology was unclear. This report highlights the diagnostic dilemma of TMA in a pregnant kidney transplant recipient and a role for the anti-C5 terminal complement blockade monoclonal antibody eculizumab, in pregnancy-associated TMA, especially at a peri-viable gestation.<\/jats:p>","DOI":"10.1155\/2024\/9218637","type":"journal-article","created":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T18:20:08Z","timestamp":1714242008000},"page":"1-5","source":"Crossref","is-referenced-by-count":1,"title":["The Challenges of Distinguishing Different Causes of TMA in a Pregnant Kidney Transplant Recipient"],"prefix":"10.1155","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8467-2469","authenticated-orcid":true,"given":"A.","family":"Krelle","sequence":"first","affiliation":[{"name":"Department of Obstetric Medicine, Royal Women\u2019s Hospital, Flemington Rd, Parkville, Victoria, Australia"},{"name":"Department of Nephrology, Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7722-3171","authenticated-orcid":true,"given":"S.","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Obstetric Medicine, Royal Women\u2019s Hospital, Flemington Rd, Parkville, Victoria, Australia"},{"name":"Department of Obstetric Medicine, Frances Perry House, Flemington Rd, Parkville, Victoria, Australia"},{"name":"Department of Medicine, University of Melbourne, Grattan St, Parkville, VIC, Australia"},{"name":"Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7927-7616","authenticated-orcid":true,"given":"M. M.","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Obstetric Medicine, Royal Women\u2019s Hospital, Flemington Rd, Parkville, Victoria, Australia"},{"name":"Department of Nephrology, Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia"},{"name":"Department of Medicine, University of Melbourne, Grattan St, Parkville, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1739-5208","authenticated-orcid":true,"given":"S.","family":"Kranz","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1286-0270","authenticated-orcid":true,"given":"P.","family":"Shamdasani","sequence":"additional","affiliation":[{"name":"Department of Obstetric Medicine, Royal Women\u2019s Hospital, Flemington Rd, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5172-3263","authenticated-orcid":true,"given":"S.","family":"Kane","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine, Royal Women\u2019s Hospital, Flemington Rd, Parkville, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, University of Melbourne, Grattan St, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1799-9191","authenticated-orcid":true,"given":"J.","family":"Unterscheider","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine, Royal Women\u2019s Hospital, Flemington Rd, Parkville, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, University of Melbourne, Grattan St, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5051-3854","authenticated-orcid":true,"given":"P.","family":"Champion de Crespigny","sequence":"additional","affiliation":[{"name":"Department of Obstetric Medicine, Royal Women\u2019s Hospital, Flemington Rd, Parkville, Victoria, Australia"},{"name":"Department of Nephrology, Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia"},{"name":"Department of Medicine, University of Melbourne, Grattan St, Parkville, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-019-1560-2"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50676"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1016\/j.preghy.2018.02.007"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020005221"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2021.03.006"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.07.038"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-022-01299-9"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.123.20987"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1308826"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.01.035"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-021-00424-4"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1007\/s11906-017-0784-4"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.03098"},{"issue":"1","key":"14","doi-asserted-by":"crossref","DOI":"10.1161\/HYPERTENSIONAHA.115.05484","article-title":"Classional complement pathway activation in the kidneys of women with preeclampsia","volume":"66","author":"M. 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