Abstract
Malignant-phase hypertension is characterized clinically by severe accelerating hypertension with neuroretinopathy or papilledema and by evidence of renal damage. A Japanese male in his early thirties presented with hemoptysis and general fatigue. He had a 5-year history of hypertension, but had not received any treatment. His blood pressure was 290/150 mmHg and his serum creatinine level was 8.24 mg/dL. Chest X-rays and computed tomography scans of the chest revealed a pulmonary alveolar hemorrhage. He was suspected of having vasculitis syndrome or Goodpasture’s syndrome, but his renal biopsy specimen showed malignant nephrosclerosis. Myeloperoxidase antineutrophil cytoplasmic antibody (ANCA), proteinase-3 ANCA and antiglomerular basement membrane antibody were negative. He was treated with a calcium antagonist and a β-blocker, followed by an angiotensin-converting enzyme inhibitor. After the administration of the β-blocker, his blood pressure decreased and his renal function gradually improved. This is a rare case of malignant-phase hypertension with pulmonary alveolar hemorrhage; this condition should be considered in the differential diagnosis in order to avoid unnecessary treatment such as immunosuppressive therapy.
Similar content being viewed by others
References
Lip GY, Beevers M, Beevers DG. Complications and survival of 315 patients with malignant-phase hypertension. J Hypertens. 1995;13:915–24.
Sesoko S, Akema N, Matsukawa T, Kaneko Y. Predisposing factors for the development of malignant essential hypertension. Arch Intern Med. 1987;147:1721–4.
Isles CG, Johnson AO, Milne FJ. Slow release nifedipine and atenolol as initial treatment in blacks with malignant hypertension. Br J Clin Pharmacol. 1986;21:377–83.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28:1462–536.
Nakamoto H, Nemoto H, Sugahara S, Okada H, Suzuki H. Nifedipine and arotinolol in combination for accelerated-malignant hypertension: results of one year follow-up. Hypertens Res. 1999;22:75–80.
De Lassence A, Fleury-Feith J, Escudier E, Beaune J, Bernaudin JF, Cordonnier C. Alveolar hemorrhage. Diagnostic criteria and results in 194 immunocompromised hosts. Am J Respir Crit Care Med. 1995;151:157–63.
Hida K, Wada J, Odawara M, Kunitomi M, Hayakawa N, Kashihara N, et al. Malignant hypertension with a rare complication of pulmonary alveolar hemorrhage. Am J Nephrol. 2000;20:64–7.
Sato Y, Hara S, Yamada K, Fujimoto S. A rare case of alveolar haemorrhage due to malignant hypertension. Nephrol Dial Transplant. 2005;20:2289–90.
Torra R, Poch E, Torras A, Bombi JA, Revert L. Pulmonary hemorrhage as a clinical manifestation of hemolytic-uremic syndrome associated with mitomycin C therapy. Chemotherapy. 1993;39:453–6.
Piastra M, Ruggiero A, Langer A, Caresta E, Chiaretti A, Pulitano S, et al. Pulmonary hemorrhage complicating a typical hemolytic-uremic syndrome. Respiration. 2004;71:537–41.
Martinez AJ, Maltby JD, Hurst DJ. Thrombotic thrombocytopenic purpura seen as pulmonary hemorrhage. Arch Intern Med. 1983;143:1818–20.
Srivastava A, Gottlieb D, Bradstock KF. Diffuse alveolar haemorrhage associated with microangiopathy after allogeneic bone marrow transplantation. Bone Marrow Transplant. 1995;15:863–7.
Naniwa T, Banno S, Sugiura Y, Yokota K, Oosawa T, Maeda S, et al. Pulmonary-renal syndrome in systemic sclerosis: a report of three cases and review of the literature. Mod Rheumatol. 2007;17:37–44.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Nanba, K., Yahata, K., Kikuchi, Y. et al. A rare case of malignant-phase hypertension with pulmonary alveolar hemorrhage. Clin Exp Nephrol 15, 303–307 (2011). https://doi.org/10.1007/s10157-010-0397-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-010-0397-6