MALIGNANT HYPERTENSION COMPLICATED BY RENAL THROMBOTIC MICRO ANGIOPATHY: ROLE OF ADAM 13 MUTATIONAL ANALYSIS

Authors

  • Ishma Aijazi Dubai hospital Dubai Health Authority United Arab Emirates
  • Fadhil Al Shama Department of internal medicine Dubai hospital Dubai United Arab emirates
  • Lakshmiah Ganapathy Raman
  • Sara Muhtiar

Abstract

We report a case of a 38-year-old U.A.E national who presented with malignant hypertension and features of thrombotic microangiopathy. He presented with oliguria, renal failure, thrombocytopenia and haemolytic anaemia. He required several sessions of renal replacement therapy. ADAM 13 mutational analysis was sent to differentiate Thrombotic micro angiopathy due to thrombotic thrombocytopenic purpura (TTP) or malignant hypertension. Renal biopsy revealed histopathological features of malignant arteriolar nephrosclerosis (MANS). Haemolytic parameters improved after control of blood pressure and he was subsequently discharged with early nephrology follow up.Keywords: Malignant hypertension; Thrombotic Microangiopathy; MANS; Malignant arteriolar nephrosclerosis; Haemolytic uremic syndrome; HUS; Thrombotic thrombocytopenic purpura; TTP

Author Biography

Ishma Aijazi, Dubai hospital Dubai Health Authority United Arab Emirates

senior specialist registrarinternal medicine departmentDubai hospitalDubaiU.A.E

References

Higashi AY, Nogaki F, Ono T, Fukatsu A. Case of kidney failure with thrombotic microangiopathy lesions in renal biopsy caused by accelerated hypertension in young adult. Nihon Jinzo Gakkai Shi 2009;51(7):878–83.

Khanna A, McCullough PA. Malignant hypertension presenting as hemolysis, thrombocytopenia, and renal failure. Rev Cardiovasc Med 2003;4(4):255–9.

Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic Venous Disease. N Engl J Med 2006;355(5):488–98.

Zhang B, Xing C, Yu X, Sun B, Zhao X, Qian J. Renal Thrombotic Microangiopathies Induced by Severe Hypertension. Hypertens Res 2008;31(3):479–83.

Feldman JM. Falsely elevated urinary excretion of catecholamines and metanephrines in patients receiving labetalol therapy. J Clin Pharmacol 1987;27(4):288–92.

van den Born BJ, van der Hoeven NV, Groot E, Lenting PJ, Meijers JC, Levi M, et al. Association Between Thrombotic Microangiopathy and Reduced ADAMTS13 Activity in Malignant Hypertension. Hypertension 2008;51(4):862–6.

George JN. How I treat patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Blood 2000;96(4):1223–9.

Shibagaki Y, Fujita T. Thrombotic microangiopathy in malignant hypertension and hemolytic uremic syndrome (HUS)/Thrombotic thrombocytopenic purpura (TTP): Can we differentiate one from the other? Hypertens Res 2005;28(1):89–95.

Remuzzi G. Is ADAM 13 defeciency specific to thrombotic thrombocytopenic purpura? No. J Thromb Haemost 2003;1(4):632–4.

Published

2017-06-25

Most read articles by the same author(s)