Malignant Hypertension with Thrombotic Microangiopathy

Mitaka, Hayato; Yamada, Yuji; Hamada, Osamu; Kosaka, Shintaro; Fujiwara, Naoki; Miyakawa, Yoshitaka

doi:10.2169/internalmedicine.55.6332

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…MHT is characterized by severe hypertension and multi-organ ischemic complications including TMA. [ 3 , 4 ] The diagnostic criterion of MHT includes diastolic BP ≥120 mm Hg, along with ocular hemorrhages and exudates with papilledema (grade IV Kimmelstiel-Wilson retinopathy), [ 5 , 6 ] and TMA should be diagnosed by decreased platelets (typically < 10–30 × 10 9 /L), microangiopathic hemolytic anemia (typically 80–100 g/L), with schistocytes (typically > 1%) in the peripheral blood smear, elevated lactate dehydrogenase, and multiple organs dysfunction, such as kidneys. [ 7 , 8 ] The spleen has been rarely reported to be involved in MHT-induced TMA with confirmed evidence of splenic histology, as seen in the case reported here.…”

Section: Discussionmentioning

confidence: 99%

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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%

“…MHT could also cause thrombotic microangiopathy (TMA) changes. [ 2 , 3 ] Herein, we reported a rare case of MHT inducing splenic TMA, proven by the pathological study of the spleen conducted after the splenectomy of the patient.…”

Section: Introductionmentioning

confidence: 99%

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

Ding

2020

Medicine

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“…Malignant hypertension (MH) is characterized by severe hypertension and hypertensive retinopathy that results in bilateral flame-shaped hemorrhages in the retina and papilledema [ 1 , 2 ]. In rare cases, patients with MH exhibit thrombotic microangiopathy (TMA) that develops because of mechanical stress on the red blood cells as they pass through narrowed arteries due to fibrinoid necrosis or edema caused by severe hypertension [ 2 , 3 ]. Although plasma exchange is the treatment of choice when TMA is suspected, recent reports indicate that immediate blood pressure control should be prioritized for TMA secondary to MH because of its pathophysiology, rendering plasma exchange unnecessary.…”

Section: Introductionmentioning

confidence: 99%

Thrombotic Microangiopathy Due to Malignant Hypertension Treated Exclusively With Antihypertensive Therapy

Asano¹,

Mori²

2022

Cureus

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Plasma exchange is the commonly considered therapy for the treatment of thrombotic microangiopathy (TMA); however, it is not always mandatory. We treated a patient who presented with malignant hypertension (MH) complicated by TMA using antihypertensive therapy that was not accompanied by plasma exchange. A 38-year-old woman with photophobia, diarrhea, fever, and severely elevated blood pressure was referred to our hospital. Blood test results revealed thrombocytopenia and hemolytic anemia, and ascites were observed on the computed tomography images. Although TMA was suspected, plasma exchange was not performed because the platelet count was not markedly low. Her blood cell counts improved after antihypertensive treatment, and she was discharged. The patient is currently under therapy and remains stable. Thus, TMA secondary to MH may improve using antihypertensive therapy, without the need for invasive plasma exchange. Considering the platelet count may be helpful in deciding whether plasma exchange is required.

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“…Hypertensive emergency induces acute and chronic targeted organ damage to the brain, heart, kidney, large blood vessels due to high blood pressure (1, 2). Generally, diffuse alveolar hemorrhaging (DAH) is uncommon in patients with hypertensive emergency (3, 4). Therefore, if a patient who presents with DAH develops renal failure, it might be difficult to rule out antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis or Goodpasture syndrome at presentation.…”

Section: Introductionmentioning

confidence: 99%

Diffuse Alveolar Hemorrhaging with Hypertensive Emergency: A Rare but Important Cause of Hemoptysis

et al. 2019

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Hypertensive emergency, which occurs even in young adults, induces systemic organ damage and results in a poor prognosis. We herein report the case of a 27-year-old man who developed alveolar hemorrhaging with hypertensive emergency. He presented with bloody sputum, renal failure, and extremely high blood pressure (200/128 mmHg). Chest computed tomography revealed diffuse bilateral alveolar infiltrates suggestive of diffuse alveolar hemorrhaging. After intensive therapy with anti-hypertensive drugs, the alveolar hemorrhaging disappeared. Renal impairment was partially reversed. Therefore, we conclude that hypertensive emergency should be considered as a possible cause of hemoptysis, even in young adults.

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Malignant Hypertension with Thrombotic Microangiopathy

Cited by 14 publications

References 16 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

Thrombotic Microangiopathy Due to Malignant Hypertension Treated Exclusively With Antihypertensive Therapy

Diffuse Alveolar Hemorrhaging with Hypertensive Emergency: A Rare but Important Cause of Hemoptysis

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