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This supports a multiple hit theory for the development of aHUS in this patient.
A multiple hit theory can be suggested, in which repeated challenges lead to the clinical picture of ALI/ARDS.
The current pathophysiological model of ANFH postulates a multiple hit theory such that with an increasing number of risk factors the chance of ANFH increases [ 20].
Several studies have reported the multiple hit theory as the main cause of ARDS in previously healthy lungs (transfusion, cardiopulmonary bypass [CPB], sepsis etc).. Recently, many investigators have reported that, in healthy lungs, mechanical ventilation can aggravate the 'one hit' ventilator-induced lung injury (VILI), even when using the least injurious settings.
The findings that pre-alloHCT osteonecrosis status was a risk factor for post-alloHCT osteonecrosis, and that GVHD was not an important risk factor during 3 years of follow-up supports the multiple hit theory of osteonecrosis; [ 37, 38] steroid exposure imparts secondary rather than primary insult on the osteonecrosis pathway.
Similar(54)
Even in individuals with multiple genetic/acquired risk factors, aHUS may not occur until adulthood, indicating that a triggering event that activates the alternative pathway is required for disease manifestation in genetically susceptible individuals (the multiple hits theory).
Moreover, they are also in agreement with the more recent "multiple parallel hits" theory including genetic predisposition, intestinal macrobiota and insulin resistance as the major contributors of increased oxidative stress and progressive liver damage [ 10].
Additional theories, such as the multiple-hit hypothesis, suggest factors including adipokines and mitochondrial dysfunction may also contribute to NAFLD [ 9].
Our results thus strengthen the multiple-hit hypothesis [ 4, 42].
There is indeed clinical evidence supporting this multiple-hit hypothesis.
Host predisposing conditions act as a first hit in healthy lungs, where multiple hit can induce ARDS.
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multiple hit hypothesis
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