Abstract
A 28-year-old woman with a 5-year history of untreated hypertension was admitted for respiratory distress, hemoptysis, and retinopathy. Computed tomography showed diffuse plaques in both lung fields. Acute kidney injury, hemolytic anemia, and thrombocytopenia were noted. Kidney biopsy showed thrombosis with fibrinoid necrosis and edematous intimal thickening and luminal narrowing of the small renal artery, indicating thrombotic microangiopathy; the majority of glomeruli were collapsed. After 8 weeks of treatment with antihypertensive drugs, serum creatinine decreased to 1.0 mg/dL, and the patient recovered. In the absence of any other underlying disease, malignant nephrosclerosis associated with a hypertensive emergency was diagnosed.
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Abbreviations
- CT:
-
Computed tomography
- HUS:
-
Hemolytic uremic syndrome
- TMA:
-
Thrombotic microangiopathy
References
Jawton W, Dibona GF, Kopp UC, Luft FC. Hypertensive urgencies and emergencies. In: Johnson RJ, Feehally J, Floege J, editors. Comprehensive clinical nephrology. 5th ed. Elsevier: Philadelphia; 2015. p. 399–400.
Nonaka K, Ubara Y, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Hoshino J, Sawa N, Takaichi K, Kuroda Y, Oohashi K. Clinical and pathological evaluation of hypertensive emergency-related nephropathy. Intern Med. 2013;52(1):45–53.
Olson JL. Renal disease caused by hypertension. In: Jemmette JC, Olson JL, Silva FG, D’Agati VD, editors. Heptinstall’s pathology of the kidney. 7th ed. Wolters Kluwer: Philadelphia; 2015. p. 852–96.
Fogo AB. Accelerated/malignant hypertension. In: Fogo AB, Kashgarian M, editors. Diagnostic atlas of renal pathology. 7th ed. Philadelphia: Elsevier; 2005. pp. 332–43.
Farris AB, et al. Hypertensive renovascular disease. In: Cornell LD, Farris AB, Kambham N, Meehan S, et al., editors. Diagnostic pathology Kidney disease. 3rd ed. Elsevier: Philadelphia; 2019. p. 558–65.
Yamanouchi M, Ubara Y, Imafuku A, Kawada M, Koki M, Sumida K, Hiramatsu R, Hasegawa E, Hayami N, Suwabe T, Hoshino J, Sawa N, Ohashi K, Fujii T, Matsuda M, Takaichi K. Malignant nephrosclerosis in a patient with familial Mediterranean fever. Intern Med. 2015;54(20):2643–2643.
Sekine A, Hasegawa E, Hiramatsu R, Mise K, Sumida K, Ueno T, Yamanouchi M, Hayami N, Suwabe T, Hoshino J, Sawa N, Takaichi K, Ohashi K, Fujii T, Ubara Y. Two types of renovascular lesions in lupus nephritis with clinical thrombotic thrombocytopenic purpura. Case Rep Nephrol Dial. 2015;5(3):192–9.
Suenaga A, Sawa N, Oshima Y, Ikuma D, Oba Y, Yamanouchi M, Hasegawa E, Mizuno H, Sekine A, Suwabe T, Kono K, Kinowaki K, Ohashi K, Takemura T, Yamaguchi Y, Miyazono M, Atsumi T, Ubara Y. A case of antiphospholipid syndrome nephropathy related disease diagnosed by assessing phosphatidylserine-dependent antiprothrombin antibodies. Intern Med. 2023;62:757–61.
Suenaga A, Sawa N, Miki K, Yokoyama T, et al. A case of antiphospholipid syndrome nephropathy with acute thrombotic microangiopathy after renal transplantation. Intern Med. 2023;62:2707–13.
Takada D, Hoshino J, Kikuchi K, Yabuuchi J, Kogure Y, Ueno T, Sekine A, Yamanouchi M, Sumida K, Mise K, Suwabe T, Hayami N, Sawa N, Takaichi K, Hayasi N, Fujii T, Ohashi K, Ubara Y. Anti-RNA polymerase III antibody-associated scleroderma renal crisis in a patient with limited cutaneous systemic sclerosis: a case report. Mod Rheumatol. 2018;28(2):369–72.
Fukuda M, Mizuno H, Hiramatsu R, Sekine A, Kawada M, Hasegawa E, Yamanouchi M, Suwabe T, Hoshino J, Sawa N, Takaichi K, Kinowaki K, Ohashi K, Fujii T, Miyazono M, Ubara Y. A case of thrombotic microangiopathy associated with polymyositis. Clin Nephrol. 2021;95(6):339–44.
Kurihara S, Sawa N, Inui K, Ikuma D, Oba Y, Mizuno H, Sekine A, Yamanouchi M, Hasegawa E, Suwabe T, Kono K, Kinowaki K, Ohashi K, Tomita S, Okubo T, Ubara Y. Onion skin lesion of the renal small artery in a patient with polymyositis and hemolytic uremic syndrome. Kidney Med. 2022;4(10): 100539.
Mise K, Ubara Y, Matsumoto M, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, Hayami N, Suwabe T, Hoshino J, Sawa N, Ohashi K, Kokame K, Miyata T, Fujimura Y, Takaichi K. Long term follow up of congenital thrombotic thrombocytopenic purpura (Upshaw-Schulman syndrome) on hemodialysis for 19 years: a case report. BMC Nephrol. 2013;20(14):156.
Ubara Y, Hara S, Katori H, Yamada A, Morii H. Renovascular hypertension may cause nephrotic range proteinuria and focal glomerulosclerosis in contralateral kidney. Clin Nephrol. 1997;48(4):220–3.
Sato H, Saito T, Kasai Y, Abe K, Yoshinaga K. Massive proteinuria due to renal artery stenosis. Nephron. 1989;51(1):136–7.
Basrak MT, Alhammad MF, Anjum S, Altermanini M, Ahmed YE. Diffuse alveolar hemorrhage: a rare complication of severe hypertension. Cureus. 2023;15(1): e33933.
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Ubara, Y., Kurihara, S., Tsuchiya, Y. et al. A case of hypertensive emergency with alveolar hemorrhage and thrombotic microangiopathy. CEN Case Rep (2024). https://doi.org/10.1007/s13730-024-00863-5
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DOI: https://doi.org/10.1007/s13730-024-00863-5