Bilateral disc edema in hypertensive emergency

Shah, Bhavik; Sadaka, Ama; Berry, Shauna; Malik, Amina I.; Lee, Andrew G.

doi:10.1016/j.jcjo.2017.08.015

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…The intersection between systemic hypertension and optic disc edema is complex and may be in part explained by: (1) excessive cerebral blood flow leading to vasogenic edema and increased ICP, (2) ischemia leading to fibrinoid necrosis and cytotoxic edema, and/or (3) hypertension leading to retinopathy with optic nerve involvement. 1 The connection between kidney failure and increased ICP has been reported with primary IIH. Animal and pathology studies have demonstrated elevated ICP with kidney impairment [7][8][9][10] and suggest this could be due to fluid overload, anemia, and increased cerebral blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic hypertensive changes are frequently also evident, including segmental arteriolar narrowing, wall opacification, arteriovenous crossing changes, and microaneurysms. 1 …”

Section: Introductionmentioning

confidence: 99%

“…Chronic hypertensive changes are frequently also evident, including segmental arteriolar narrowing, wall opacification, arteriovenous crossing changes, and microaneurysms. 1 Bilateral disc edema can occur with hypertensive retinopathy but when severe, raises concern for increased intracranial pressure (ICP) and necessitates evaluation with neuroimaging, confirmatory lumbar puncture with opening pressure, and relevant cerebrospinal fluid (CSF) studies. There are reports in the literature of concurrent increased ICP with papilledema in the setting of malignant hypertension.…”

Section: Introductionmentioning

confidence: 99%

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Papilledema and retinopathy lead to diagnosis of IgA nephropathy: a case report

Kwan

Lanzo

Ramsey

et al. 2023

Therapeutic Advances in Rare Disease

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This case features a young healthy male who was diagnosed with immunoglobulin A (IgA) nephropathy after presenting with blurry vision that was caused by hypertensive retinopathy and papilledema. In this report, we examine the relationship between hypertension and increased intracranial pressure (ICP), along with the ocular signs of IgA nephropathy that may present in the setting of kidney disease. Plain Language Summary Immunoglobulin A (IgA) nephropathy is an immune-mediated inflammatory condition that affects the kidneys and is characterized by deposits of IgA antibodies across the body. Nephropathy in general is defined as the deterioration of kidney function. Hypertension is a common complication because of the resultant kidney damage. IgA can also deposit widely across the body, including within the eyes, and may lead to various inflammatory manifestations affecting the front and back of the eyes. We present a case of a 38-year-old male with 2 weeks of worsening vision and headaches. His blood pressure was extremely high (206/116 mmHg) and he was found to have acute kidney injury. Examination of his eye revealed hypertensive retinopathy but also significant swelling of both of his optic discs, concerning for increased intracranial pressure (ICP), which is unusual in a young, otherwise healthy male. The investigation for the cause of increased ICP led to the diagnosis of IgA nephropathy. Treatment of his increased ICP and blood pressure resulted in improvement of his vision. It is important to consider increased ICP as a cause of optic disc swelling in patients with very high blood pressures. Prompt evaluation and management of elevated ICP is important to preserve vision, prevent brain complications and diagnose the underlying disease process. Especially important is the communication and coordination across medical specialties to ensure safe treatment given the multisystem organ involvement. In this article, we also review the eye findings associated with IgA nephropathy, as well as other immune-mediated complications of this rare disease.

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Section: Discussionmentioning

confidence: 99%

“…Chronic hypertensive changes are frequently also evident, including segmental arteriolar narrowing, wall opacification, arteriovenous crossing changes, and microaneurysms. 1 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Papilledema and retinopathy lead to diagnosis of IgA nephropathy: a case report

Kwan

Lanzo

Ramsey

et al. 2023

Therapeutic Advances in Rare Disease

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“…Pacientes com HTM frequentemente relatam visão turva ou manchas visuais sintomáticas. Os achados retinianos associados incluem: hemorragias em chama, manchas algodonosas, infartos da coroide, edema macular com exsudatos duros e inchaço do disco óptico com hemorragias discais 20 .…”

Section: Discussionunclassified

Hipertensão maligna em paciente com nefropatia por imunoglobulina a (NIgA)

Nunes,

Lima,

Marinho

2024

Braz. J. Hea. Rev.

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INTRODUÇÃO: A Nefropatia por IgA (NIgA) é a doença glomerular mais comum do mundo e possui apresentação clínica variada. Dentre o espectro de manifestação clínica, está a Hipertensão Maligna (HTM) associada à NIgA. OBJETIVO: relatar o caso de um paciente com NIgA associado à HTM com retinopatia hipertensiva. CASO CLÍNICO: paciente, sexo masculino, 25 anos, previamente hígido, com quadro de cefaleia intensa associado à náusea e vômitos e acuidade visual diminuída. Avaliação com oftalmologia evidenciou lesões características de Retinopatia Hipertensiva; pressão arterial 227x161mmHg. Encaminhado para Pronto-Socorro e internado em UTI. Exames laboratoriais com elevação dos níveis de ureia e creatinina sem indicação dialítica, elementos anormais e sedimentoscopia com sedimento ativo e hematúria com dismorfismo eritrocitário. Paciente foi submetido à pulsoterapia com metilprednisolona por três dias. Transferido posteriormente para hospital terciário para investigação diagnóstica. Biópsia percutânea renal revelou NIgA e foi iniciada prednisona diária com programação de desmame, bem como medidas anti-proteinúricas e anti-hipertensivos. Em acompanhamento ambulatorial, observou-se melhora dos níveis pressóricos após associação de anti-hipertensivos, diminuição da proteinúria e estabilidade da função renal. CONCLUSÃO: O paciente evoluiu com estabilização da função renal e desmame satisfatório de parte dos anti-hipertensivos após duas semanas de internação, fazendo uso na alta de losartana 100 mg/dia, com pressão arterial estabilizada em torno de 140x80 mmHg.

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“…There is significant overlap among patients with other hypertensive emergencies and MHT, i.e., complicated MHT, when MHT is accompanied by additional life-threatening EOD as described under section 2.2, it should be managed as a hypertensive emergency [13][14][15]. Patients with hypertensive emergencies may also be referred to as hypertension-multiorgan damage (MOD) [15].…”

Section: Malignant Hypertensionmentioning

confidence: 99%

Management of hypertensive crisis: British and Irish Hypertension Society Position document

et al. 2022

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Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice. Initiating anti-hypertensive therapy and setting BP goal in acute settings requires important considerations which differ slightly across various diagnoses and clinical contexts. This position paper by British and Irish Hypertension Society, aims to provide clinicians a framework for diagnosing, evaluating, and managing patients with hypertensive crisis, based on the critical appraisal of available evidence and expert opinion.

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Bilateral disc edema in hypertensive emergency

Cited by 6 publications

References 6 publications

Papilledema and retinopathy lead to diagnosis of IgA nephropathy: a case report

Papilledema and retinopathy lead to diagnosis of IgA nephropathy: a case report

Hipertensão maligna em paciente com nefropatia por imunoglobulina a (NIgA)

Management of hypertensive crisis: British and Irish Hypertension Society Position document

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