Consensus recommendations on clinical criteria for genetic screening of atypical hemolytic uremic syndrome in end-stage kidney disease patients listed for kidney transplantation: Insights from the United Arab Emirates (Emirates Medical Association Nephrology and Transplantation [EMAN-T] Society)

Background Atypical haemolytic uraemic syndrome (aHUS) is an uncommon complement-mediated thrombotic microangiopathy that often leads to end-stage kidney disease and carries a high risk of post-transplant recurrence. In the United Arab Emirates (UAE), many cases of end-stage kidney disease lack a defined aetiology, which raises concern that some may progress to unrecognised aHUS. Identifying high-risk patients before transplantation may enable targeted prophylaxis and improve graft outcomes. Methods A modified Delphi method was employed involving 10 senior nephrologists representing academic, public, and private institutions across the UAE. Following a literature review on aHUS diagnosis, complement genetics, and transplant outcomes, eight consensus statements were drafted addressing disease recognition, indications for genetic testing, referral pathways, and implementation strategies. Results All panellists completed both Delphi rounds (100% response rates). In Round 1, all eight statements met predefined consensus criteria. Four statements were further refined based on qualitative feedback and re-assessed in Round 2, after which they all achieved 100% agreement. Key recommendations included targeted genetic testing of patients with end-stage kidney disease who are younger than 50 years and have unknown aetiology, along with additional clinical features suggestive of complement-mediated thrombotic microangiopathy; implementation of unified protocols for referral and diagnosis of aHUS; structured pre-test genetic counselling and clear referral mechanisms to genetic services; and establishment of a national aHUS registry. Conclusion This national consensus provides a framework for risk-based genetic evaluation of suspected aHUS in end-stage kidney disease and transplant candidates in the UAE.