Hypertension causing thrombotic microangiopathy (TMA) is one of the several etiologies of TMA, which causes endothelial damage and thrombosis of microvasculature, leading to hemolytic anemia, thrombocytopenia, and ischemic organ damage. Renal microvasculature involvement leading to renal dysfunction is most frequently seen in TMA but the degree of dysfunction varies with etiology. If left untreated, TMA carries a risk of high mortality, so it is extremely important for early identification of the cause of TMA. Plasma exchange is a commonly used treatment modality for TMA; however, it is not always necessary. Hypertension-induced TMA can be safely treated with antihypertensives, without the need for invasive plasma exchange. We report a 37-year-old African American hypertensive lady presenting with hypertensive emergency and TMA with rapidly progressing renal dysfunction. The patient had improvement in her platelet count after her blood pressure was reduced in a controlled manner.
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http://dx.doi.org/10.7759/cureus.24237 | DOI Listing |
Cureus
December 2024
Nephrology, Nagasaki University Hospital, Nagasaki, JPN.
Thrombopoietin receptor agonists are used in addition to steroids for idiopathic thrombocytopenic purpura. A 55-year-old male with idiopathic thrombocytopenic purpura, treated with eltrombopag, developed a rapid decline in renal function following the increase in eltrombopag dose. Renal biopsy showed glomerular endothelial disorder and platelet thrombus, which suggested eltrombopag-induced renal-limited thrombotic microangiopathy.
View Article and Find Full Text PDFFront Immunol
January 2025
Department of Rheumatology and Immunology, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China.
Introduction: Systemic lupus erythematosus (SLE) complicated by thrombotic microangiopathy (TMA) and non-cirrhotic portal hypertension (NCPH) is rare. We present a case of a female patient with SLE who developed TMA and NCPH and responded positively to rituximab and plasma exchange treatment.
Case Description: A 53-year-old woman was admitted with 6 h of confusion.
J Pak Med Assoc
January 2025
Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Objectives: To analyse the aetiological spectrum, clinical presentation and short-term renal outcomes of patients with acute kidney injury of uncertain aetiology subjected to percutaneous renal biopsy.
Methods: The prospective, cohort study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, from March 1 to October 30, 2024, and comprised hospitalised acute kidney injury patients of either gender aged 18- 75 years who had been subjected to percutaneous renal biopsy. The patients were followed up for at least three months from the time of the biopsy.
Mol Imaging
January 2025
Nuclear Medicine Department, Montpellier University Hospital, University of Montpellier, Montpellier, France.
Immunologic thrombocytopenic purpura (ITP) is a condition that affects four to 18 per 100 000 children every year. In most cases, spontaneous remission occurs, but splenectomy may be proposed. Exploring the site of platelet sequestration can help to better predict potential poor responders to splenectomy, but In-radiolabeled platelet scintigraphy (IPS) can be difficult to perform in children with very few platelets.
View Article and Find Full Text PDFHum Gene Ther
January 2025
BridgeBio Gene Therapy, Palo Alto, California, USA.
Complement-mediated thrombotic microangiopathy (TMA) in the form of atypical hemolytic uremic syndrome (aHUS) has emerged as an immune complication of systemic adeno-associated virus (AAV) gene transfer that was unforeseen based on nonclinical studies. Understanding this phenomenon in the clinical setting has been limited by incomplete data and a lack of uniform diagnostic and reporting criteria. While apparently rare based on available information, AAV-associated TMA/aHUS can pose a substantial risk to patients including one published fatality.
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