Thrombotic microangiopathy in a pediatric patient: question (original) (raw)
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Hypertension-Induced Thrombotic Microangiopathy Leading to End-Stage Renal Disease
Cureus
Thrombotic microangiopathy (TMA) is a term used for a group of rare and life-threatening hematological conditions. Usually, these disease processes are characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and microthrombi leading to tissue or organ injury. We present a case of a 41year-old male with TMA induced by uncontrolled hypertension leading to end-stage renal disease requiring hemodialysis. Our goal is to highlight the importance of distinguishing hypertension-induced thrombotic microangiopathy from other etiologies of TMA, particularly thrombotic thrombocytopenic purpura (TTP), and its effect on renal function despite treatment focused on blood pressure control. Thus, it is a challenging diagnosis for clinicians to determine whether to initiate plasmapheresis for prompt treatment of suspected TTP in the setting of severe hypertension with thrombocytopenia.
A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency
Cureus, 2018
A 26-year-old man presented to the emergency room with abdominal pain, nausea, and vomiting for four days. His medical history was significant for hypertension and end-stage renal disease managed with hemodialysis. He had been noncompliant with the antihypertensive regimen which included nifedipine, hydralazine, and spironolactone. At presentation, his blood pressure was 231/123 mmHg. Laboratory workup showed white blood count 17.3 × 109/L (normal range: 4.5 to 11.0 × 109/L), hemoglobin 7.8 gm/dL (normal range: 13.5 to 17.5 g/dL), platelet count 46 × 109/L (normal range: 150 to 400 × 109/L), reticulocyte count 7.8%, total bilirubin 1 mg/dL (normal range: 0.1 to 1.2 mg/dL), lactate dehydrogenase 1,235 U/L (normal range: 140 to 280 U/L), haptoglobin < 10 mg/dL, and a direct Coomb's test was negative. Numerous schistocytes were identified on the peripheral blood smear. The patient was diagnosed with thrombotic microangiopathy secondary to severe hypertension and was started on i...
Hypertension and reduced renal function in an 83-year-old patient
Internal and Emergency Medicine, 2006
An 83-year-old woman was admitted to our department for a hypertensive crisis. Essential hypertension was diagnosed 30 years ago and was treated with different drugs. At the age of 79 years, the patient had symptomatic atrial fibrillation and was treated with DC-shock. On that occasion hypercholesterolaemia was diagnosed (total cholesterol 290 mg/dl) and mild, not haemodynamically significant, atherosclerosis of carotid and femoral arteries so that treatment with statin was started. One month before admission, she started complaining of mild dyspnoea and palpitations during the night associated with elevated blood pressure (BP) values (170/100 mmHg). Diuretic was added to current treatment without any significant BP reduction. Due to a new hypertensive crisis complicated by pulmonary oedema, she was referred to our department in emergency. At referral, the patient was under treatment with felodipine (10 mg), enalapril (20 mg), hydrochlorothiazide (12.5 mg) and propafenone (75 mg twice daily). On admission, the patient was alert, oriented, dyspnoic. BP was 190/110 mmHg at both arms, the pulse was rhythmic (75 bpm). Body weight was 67 kg with 167 cm height. Bilateral basal rales were present at pulmonary auscultation with third sound at cardiac auscultation. On abdominal examination, the liver and spleen were normal and no abdominal bruit was found. Mild peripheral oedema and moderate jugular venous distension were also present. All peripheral pulses were symmetrically present and no carotid or femoral bruits were found.
A Patient with Acute Kidney Pain and High BP
Clinical journal of the American Society of Nephrology : CJASN, 2015
This case presented challenging diagnostic and management issues in a young healthy man who presented with abdominal pain and new-onset hypertension. The differential diagnosis evolved over the course of the clinical presentation. The patient had severe vascular involvement of his renal and basal cerebral arteries that initially was assumed to be due to a vasculitic process or hypercoagulable state. Finally it became apparent that the patient did not have a systemic illness but rather a localized vascular disease most likely due to segmental arterial mediolysis, a rare, under-recognized condition that can potentially be fatal. This condition is often difficult to distinguish from fibromuscular dysplasia. It is important to recognize and correctly diagnose the condition, particularly in the acute phase of the disease, because delay in diagnosis can contribute to morbidity and mortality.
Pediatric Nephrology, 2020
An 11-year-old girl was admitted to the hospital suffering from severe headache, eye pain, diplopia, loss of appetite, and vomiting lasting for 3 days. At the emergency department, the patient was somnolent with blood pressure (BP) of 180/ 130 mmHg. Electrolyte and biochemical analysis did not reveal any abnormal findings. Fundoscopy showed bilateral papilledema. Therefore, a brain computed tomography (CT) was performed with no signs of any pathologic lesions. Echocardiogram revealed left ventricular hypertrophy (LVH). Kidney ultrasound revealed hypoplastic left kidney (length 5.3 cm, < 5th centile [1]), while the right kidney showed compensatory hypertrophy (length 11.2 cm, > 95th centile [1]). The blood flow to the left renal artery measured by a Doppler ultrasound was not detectable. Therefore, kidney CT angiography was performed, which demonstrated severely stenotic left renal and left polar renal artery without segmental stenosis and an absence of the infrarenal segment of the inferior vena cava (IVC) (Fig. 1) with a collateral drainage through azygous and hemiazygos veins. DMSA kidney scan showed severe
Clinico-Histological Features of Thrombotic Microangiopathy in Renal Biopsies: A Retrospective Study
Turk patoloji dergisi, 2021
OBJECTIVE Thrombotic microangiopathy (TMA) is often first detected on a renal biopsy performed for renal manifestations. Apart from hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura, there are various secondary conditions associated with TMA. This study analyzes the clinico-pathological spectrum, etiological factors and renal outcome of TMA diagnosed on renal biopsy. MATERIAL AND METHOD A retrospective evaluation of renal biopsies for TMA over 5.5 years was performed. Clinical and laboratory data was collected from patient records. RESULTS A total of 40 biopsies from 39 patients showed TMA comprising 33 native and 7 transplant biopsies. Malignant hypertension (n=13) was the most common etiology in native biopsies followed by postpartum TMA (n=7), atypical HUS (aHUS) (n=7), and lupus nephritis (n=6). TMA in transplant biopsies was due to acute rejection (n=4) and CNI toxicity (n=3). Serum creatinine was high in most patients (mean 5.6 + 2.5 mg/ dl). aHUS showed ...