Renal Thrombotic Microangiopathy Due to Malignant Hypertension
Journal Title: Indian Journal of Emergency Medicine - Year 2017, Vol 3, Issue 2
Abstract
Malignant hypertension (MHTN) is a hypertensive emergency with end organ dysfunction and MHTN presenting as renal thrombotic microangiopathy is rare. It is characterized by microangiopathic hemolysis, anemia, thrombocytopenia, indirect hyperbilirubinemia and variable degrees of renal failure apart from papilledema and acutely elevated blood pressure. The degree of renal failure may vary depending on the extent of endothelial damage and stimulation of renin angiotensin aldosterone system. Herein, we report a rare case of malignant hypertension in a young boy with renal TMA. He has bilateral papilledema and initial blood pressure of 210/100 mm of Hg. He has features of microangiopathic hemolysis and severe oliguric renal failure. His blood pressure was managed in Emergency Department with IV nitroglycerin and IV labetalol continuous infusion. He was instituted on hemodialysis through right Internal Jugular access and was continued on dialysis for the next two weeks. His blood pressure was managed with oral antihypertensives (Metaprolol (100mg/day), Nifedipine (60mg/day), Hydralazine (100mg/day), Torsemide 40mg/day). He showed good signs of improvement with adequately controlled blood pressure (140/80) and a stable renal function (Ser. Creat of 2.3 mg/dl, during last followup). Unlike Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome complex, renal TMA associated with malignant hypertension will not respond to plasmapheresis and adequate emergent management of blood pressure in emergency department will limit the extent of renal damage. The level of LDH, platelet count and hemoglobin can be used as markers of microangiopathic hemolysis. Renal recovery can vary from complete to partial recovery.
Authors and Affiliations
Harini Agnes
Keywords
Related Articles
- EP ID EP453337
- DOI 10.21088/ijem.2395.311X.3217.19
- Views 115
- Downloads 0
A Case of Myxoedema Coma: Diagnostic Challenge in ED
Myxoedema coma is life threatening emergency of decompensated hypothyroidism, recognition of hypothyroidism may not always be easy in the emergency department setting. Laboratory evaluations of thyroid function are not u...
Clinical Profile of Patients Presenting with Chest Pain to Emergency Department
Background: Chest pain may be a symptom of a number of serious conditions and generally considered as a medical emergency. In ER the typical approach to chest pain involves ruling out the most dangerous cause and elimina...
Awareness of Cardiopulmonary Resuscitation (CPR) Among General Public
Introduction: Cardiac arrest is a common medical emergency with grave consequences. Cardiac arrest occurs when the heart stop to produce an effective pulse and fails to circulate blood throughout the body. CPR is an emer...
Epidemics of Acute Encephalitis in Young Children: Lychee the Sweet Hypoglycemic or a Silent Killer
Epidemics of acute encephalitis In young children:Lychee the sweet hypoglycemic or a silent killer a review of literature.There have been reports of children presenting with acute neurological illness from Bihar India da...
Emphysematous Pyelonephritis
Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma, Perirenal tissue and its surrounding areas. We report a case of diabetes mellitus that presented to the emergency department...