Flow of clinical outcomes of patients after eculizumab discontinuation. Slowly progressive proteinuria and worsening renal function over 3 months prior to reinitiation of eculizumab in setting of a patient with baseline CKD KDIGO IIIA and a CFH variant that stabilized at an eGFR of 29 mL/min at last follow-up.² Progressive worsening renal function and long-term dialysis need²⁷ and progressive worsening of kidney function despite eculizumab reinitiation in setting of an MCP variant and progression to CKD KDIGO V requiring renal transplantation.³ Postinfectious TMA relapse on a kidney allograft with initial stabilization of renal function after eculizumab reinitiation subsequently developed overlapping acute tubular necrosis due to a second insult leading to progressive renal function loss over 6 months and, ultimately, allograft loss²⁹ and posttransplant recurrence of TMA in patient with CFI NOS variant with no response to 3 months of eculizumab retrial and subsequent allograft loss.⁴⁷ CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease.