{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T02:56:07Z","timestamp":1777776967393,"version":"3.51.4"},"reference-count":13,"publisher":"Walter de Gruyter GmbH","issue":"2","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The evidence regarding thrombotic microangiopathy (TMA) related to Coronavirus Infectious Disease 2019 (COVID-19) in patients with complement gene mutations as a cause of acute kidney injury (AKI) are limited. We presented the case of a 23-year-old male patient admitted with an asymptomatic form of COVID-19, but with uncontrolled hypertension and AKI. Kidney biopsy showed severe lesions of TMA. In evolution patient had persistent microangiopathic hemolytic anemia, decreased level of haptoglobin and increased LDH level. Decreased complement C3 level and the presence of schistocytes were found for the first time after biopsy. Kidney function progressively decreased and the patient remained hemodialysis dependent. Complement work-up showed a heterozygous variant with unknown significance in complement factor I (CFI) c.-13G&gt;A, affecting the 5\u2019 UTR region of the gene. In addition, the patient was found to be heterozygous for the complement factor H (CFH) H3 haplotype (involving the rare alleles of c.-331C&gt;T, Q672Q and E936D polymorphisms) reported as a risk factor of atypical hemolytic uremic syndrome. This case of AKI associated with severe TMA and secondary hemolytic uremic syndrome highlights the importance of genetic risk modifiers in the alternative pathway dysregulation of the complement in the setting of COVID-19, even in asymptomatic forms.<\/jats:p>","DOI":"10.2478\/rjim-2021-0040","type":"journal-article","created":{"date-parts":[[2022,1,8]],"date-time":"2022-01-08T09:55:56Z","timestamp":1641635756000},"page":"138-142","source":"Crossref","is-referenced-by-count":1,"title":["COVID-19: a trigger for severe thrombotic microangiopathy in a patient with complement gene variant"],"prefix":"10.2478","volume":"60","author":[{"given":"Larisa","family":"Pinte","sequence":"first","affiliation":[{"name":"Colentina Clinical Hospital , Internal Medicine Department , Bucharest , Romania"},{"name":"Carol Davila University of Medicine and Pharmacy , Bucharest , Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan Marian","family":"Sorohan","sequence":"additional","affiliation":[{"name":"Fundeni Clinical Institute , Department of Nephrology , Bucharest , Romania"},{"name":"Carol Davila University of Medicine and Pharmacy , Bucharest , Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zolt\u00e1n","family":"Proh\u00e1szka","sequence":"additional","affiliation":[{"name":"Department of Medicine and Hematology , Research Laboratory Semmelweis University , Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihaela","family":"Gherghiceanu","sequence":"additional","affiliation":[{"name":"Carol Davila University of Medicine and Pharmacy , Bucharest , Romania"},{"name":"Ultrastructural Pathology Laboratory , Victor Babe\u0219 National Institute of Pathology , Bucharest , Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"B\u0103icu\u015f","sequence":"additional","affiliation":[{"name":"Colentina Clinical Hospital , Internal Medicine Department , Bucharest , Romania"},{"name":"Carol Davila University of Medicine and Pharmacy , Bucharest , Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2022,6,14]]},"reference":[{"key":"2026042915193946121_j_rjim-2021-0040_ref_001","doi-asserted-by":"crossref","unstructured":"1. NG J.H., BIJOL V., SPARKS M.A., SISE M.E., IZZEDINE H., JHAVERI K.D. Pathophysiology and Pathology of Acute Kidney Injury in Patients With COVID-19. Adv Chronic Kidney Dis. 2020; 27(5):365\u201376.10.1053\/j.ackd.2020.09.003757472233308501","DOI":"10.1053\/j.ackd.2020.09.003"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_002","doi-asserted-by":"crossref","unstructured":"2. VILLE S., LE BOT S., CHAPELET-DEBOUT A., BLANCHO G., FREMEAUX-BACCHI V., DELTOMBE C., et al. Atypical HUS relapse triggered by COVID-19. Kidney Int [Internet]. 2021; 99(1):267\u20138.10.1016\/j.kint.2020.10.030765701733188793","DOI":"10.1016\/j.kint.2020.10.030"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_003","doi-asserted-by":"crossref","unstructured":"3. MAT O., GHISDAL L., MASSART A., AYDIN S., GOUBELLA A., BLANKOFF N., et al. Kidney Thrombotic Microangiopathy After COVID-19 Associated With C3 Gene Mutation. Kidney Int Reports. 2021;6(6):1732\u20137.10.1016\/j.ekir.2021.03.897802869833851069","DOI":"10.1016\/j.ekir.2021.03.897"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_004","doi-asserted-by":"crossref","unstructured":"4. KAUFELD J.K., REINHARDT M., SCHR\u00d6DER C., BR\u00c4SEN J.H., WIECH T., BRYLKA P., et al. Atypical HUS triggered by infection with SARS-CoV2. Kidney Int Reports. 2021; 6(10):2709-2712.10.1016\/j.ekir.2021.07.004826521034258481","DOI":"10.1016\/j.ekir.2021.07.004"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_005","doi-asserted-by":"crossref","unstructured":"5. ABDEL-WAHAB N., LOPEZ-OLIVO M.A., PINTO-PATARROYO G.P., SUAREZ-ALMAZOR M.E. Systematic review of case reports of antiphospholipid syndrome following infection. Lupus. 2016; 25(14):1520-1531.10.1177\/0961203316640912750815927060064","DOI":"10.1177\/0961203316640912"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_006","doi-asserted-by":"crossref","unstructured":"6. HARZALLAH I., DEBLIQUIS A., DR\u00c9NOU B. Frequency of lupus anticoagulant in COVID-19 patients. Journal of Thrombosis and Haemostasis. 2020; 18(10):2778.10.1111\/jth.14937728364032470207","DOI":"10.1111\/jth.14937"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_007","doi-asserted-by":"crossref","unstructured":"7. DEVREESE K.M.J., LINSKENS E.A., BENOIT D., PEPERSTRAETE H. Antiphospholipid antibodies in patients with COVID-19: A relevant observation?. J Thromb Haemost. 2020;18(9):2191\u2013201.10.1111\/jth.14994736125332619328","DOI":"10.1111\/jth.14994"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_008","doi-asserted-by":"crossref","unstructured":"8. PINETON DE CHAMBRUN M., FRERE C., MIYARA M., AMOURA Z., MARTIN-TOUTAIN I., MATHIAN A., et al. High frequency of antiphospholipid antibodies in critically ill COVID-19 patients: a link with hypercoagulability?. Journal of Internal Medicine. 2021; 289(3):422-424.10.1111\/joim.13126730703232529774","DOI":"10.1111\/joim.13126"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_009","doi-asserted-by":"crossref","unstructured":"9. TIWARI N.R., PHATAK S., SHARMA V.R., AGARWAL S.K. COVID-19 and thrombotic microangiopathies. Thromb Res. 2021; 202:191\u2013198.10.1016\/j.thromres.2021.04.012805592633894421","DOI":"10.1016\/j.thromres.2021.04.012"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_010","doi-asserted-by":"crossref","unstructured":"10. YU J., YUAN X., CHEN H., CHATURVEDI S., BRAUNSTEIN E.M., BRODSKY R.A. Direct activation of the alternative complement pathway by SARS-CoV-2 spike proteins is blocked by factor D inhibition. Blood. 2020; 136(18):2080\u20139.10.1182\/blood.2020008248759684932877502","DOI":"10.1182\/blood.2020008248"},{"key":"2026042915193946121_j_rjim-2021-0040_ref_011","unstructured":"11. NHLBI Exome Sequencing Project (ESP) Exome Variant Server [Internet]. 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J Med Genet. 2003; 40(9):676\u201381.10.1136\/jmg.40.9.676173558612960213","DOI":"10.1136\/jmg.40.9.676"}],"container-title":["Romanian Journal of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/reference-global.com\/pdf\/10.2478\/rjim-2021-0040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T18:41:11Z","timestamp":1777488071000},"score":1,"resource":{"primary":{"URL":"https:\/\/reference-global.com\/article\/10.2478\/rjim-2021-0040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,1]]},"references-count":13,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,6,14]]},"published-print":{"date-parts":[[2022,6,1]]}},"alternative-id":["10.2478\/rjim-2021-0040"],"URL":"https:\/\/doi.org\/10.2478\/rjim-2021-0040","relation":{},"ISSN":["2501-062X"],"issn-type":[{"value":"2501-062X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,1]]}}}