Thrombotic microangiopathy (TMA) is a lesion with multiple etiologies. The presentation depends on the cause, and typically includes the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) both manifest as TMA. In addition to classic TMA findings, HUS typically presents with bloody diarrhea, fever, and hypertension. TTP typically presents with fever, hypertension, mild proteinuria, and neurologic symptoms.