A rare case of malignant-phase hypertension with pulmonary alveolar hemorrhage

Nanba, Kazutaka; Yahata, Kensei; Kikuchi, Yūko; Okamoto, Chinatsu; Seta, Koichi; Sugawara, Akira

doi:10.1007/s10157-010-0397-6

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…In theory, MHT could damage the micro-endothelial cells of viscera such as spleen by elevated shear stress, inflammation, over-activation of complement, aberrant coagulation “storm” and so on, besides the more often targeted organs like kidney, brain and heart. [ 17 , 18 ] From the splenic pathology, we might infer inferred that MHT and TMA were the potential pathological basis for splenic rupture.…”

Section: Discussionmentioning

confidence: 99%

A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy

Ding

2020

Medicine

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Introduction: Thrombotic microangiopathy (TMA) is characterized by endothelial injury followed by formation of multiple microthrombi in the target organs due to various causes, including malignant hypertension (MHT). Here, we reported a rare case of MHT with splenic TMA changes. Case concerns: A 27-year-old Chinese Han male with a history of hypertension and proteinuria, admitted to our hospital because of renal failure with MHT and thrombocytopenia. Diagnosis: This case diagnosed with TMA based on the patient's MHT and thrombocytopenia. The patient final diagnosis was confirmed by the spleen pathological findings, other differential diagnoses were ruled out. Interventions: The patient was treated with hemodialysis and intravenous antihypertensive agents, and his condition gradually improved. However, he suddenly complained of abdominal pain and went into hemorrhagic shock, which was due to spontaneous spleen rupture on the third day of hospitalization. The pathological evidence after splenectomy showed splenic TMA. Outcomes: Hemodialysis was continued and the blood pressure was under control until his discharge from our hospital. Conclusion: Spontaneous splenic rupture could be a rare and critical complication associated with MHT-induced TMA, and it requires careful clinical attention.

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Section: Discussionmentioning

confidence: 99%

A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy

Ding

2020

Medicine

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“…We searched previous case reports on HE with DAH and compared clinical findings, renal pathological features, and prognoses. To the best of our knowledge, there have been only 6 reports of HE manifesting with DAH [ 1 , 6 , 7 , 8 , 9 , 10 ]. An overview of previous reports is shown in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Hypertensive emergency (HE) is a clinical syndrome characterized by severe hypertension with progressive renal failure, heart failure, and bilateral retinal hemorrhages and/or exudates [ 1 ]. In HE, thrombotic microangiopathy (TMA) is an occasional complication, particularly in patients with kidney impairment [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Hypertensive emergency presenting with diffuse alveolar hemorrhaging and thrombotic microangiopathy: A case report and review of the literature

Ito

Kuriyama

Kachi

et al. 2020

CNCS

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There are few studies reporting diffuse alveolar hemorrhage (DAH) caused by hypertensive emergency. We describe a 41-year-old man who visited the emergency room with hemoptysis and dyspnea. He had a 5-year history of hypertension, though he had not received any treatment. His blood pressure was 233/159 mmHg, his percutaneous oxygen saturation level was 88% on room air, and he had a serum creatinine level of 11.7 mg/dL. Laboratory data showed microangiopathic hemolytic anemia, thrombocytopenia, and severe kidney damage, suggesting thrombotic microangiopathy (TMA). Chest computed tomography and bronchoalveolar lavage revealed pulmonary alveolar hemorrhage. In addition to steroid treatment and plasma exchange, antihypertensive therapy was started immediately. On day 3, activity of a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13) activity was not significantly reduced, and clinical markers for vasculitis and connective tissue disease were negative. Therefore, steroid administration and plasma exchange were discontinued. Although antihypertensive therapy centering on angiotensin II receptor blocker was effective for DAH and TMA, renal function did not recover, and maintenance hemodialysis was required. Renal pathological findings were consistent with malignant nephrosclerosis, and features suggestive of vasculitis were not found. The pathophysiology in this case was considered to be mainly hypertension and vascular endothelial injury with renin-angiotensin-aldosterone system (RAAS) activation. The use of RAAS inhibitor was effective in converging DAH and TMA, and it was expected to repair vascular endothelial damage associated with appropriate antihypertensive intervention. The authors present this rare condition with a review of previous reports.

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“…BAL usually confirms the clinical suspicion of alveolar hemorrhage when lavage aliquots are progressively more hemorrhagic. Hemosiderin-laden macrophages can also be found [ 1 2 4 ]. Once the diagnosis of diffuse alveolar hemorrhage is achieved through BAL, the underlying cause must be rapidly established so that adequate treatment can be chosen.…”

Section: Discussionmentioning

confidence: 99%

“…Malignant hypertension is characterized by elevated blood pressure accompanying encephalopathy or acute nephropathy as target organ damage. To the best of our knowledge, there have only been five reports of malignant-phase hypertension manifesting with diffuse alveolar hemorrhage [ 4 5 6 7 8 ]. The mechanism of how malignant hypertension causes lung hemorrhage is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Alveolar Hemorrhage Due to Malignant Arterial Hypertension – an Unusual Manifestation of a Common Disease

2016

Journal of the Belgian Society of Radiology

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Diffuse alveolar hemorrhage is a clinicopathological syndrome that often leads to respiratory failure, with associated hemoptysis and anemia. Chest radiograph presents non-specific findings of perihilar infiltrates, while computed tomography shows ground-glass attenuation or areas of consolidation with interlobular septal thickening. Bronchoalveolar lavage is used to confirm the clinical and radiological suspicion.While vasculitis and other causes of pulmonary renal syndrome are the most common causes of diffuse alveolar hemorrhage, malignant hypertension should be considered in the proper clinical setting. We present a case report of a 51-year-old previously healthy patient that was diagnosed with diffuse alveolar hemorrhage and acute renal failure due to malignant hypertension, through clinical and radiological findings.

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A rare case of malignant-phase hypertension with pulmonary alveolar hemorrhage

Cited by 9 publications

References 14 publications

A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy

A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy

Hypertensive emergency presenting with diffuse alveolar hemorrhaging and thrombotic microangiopathy: A case report and review of the literature

Diffuse Alveolar Hemorrhage Due to Malignant Arterial Hypertension – an Unusual Manifestation of a Common Disease

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