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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hemolytic uremic syndrome (HUS) is defined as microangiopathic hemolytic anemia, thrombocytopenia and uremia. It is an important cause of acute renal failure (ARF) in children all over the world. The present study was carried out to assess the incidence, clinical presentation, hematological and biochemical profile of children presenting with HUS from 1987 to 1990. Out of the 100 cases who presented with ARF 22 had HUS. A majority of these children were males below 1 year of age, and had a prodromal phase of mainly gastrointestinal manifestations lasting for about a week. Anemia was a constant feature followed by bleeding diathesis, mainly melena and purpura. Neurological manifestations included altered sensorium, irritability, coma, hypertensive encephalopathy and convulsions. Renal problems mainly included oliguria, hypertension, hematuria and edema. Investigations revealed thrombocytopenia and microangiopathic hemolytic anemia in all cases. Evidence of disseminated intravascular coagulation (DIC) was observed in 3 cases as decreased fibrinogen levels, increased fibrinogen degradation products and deranged clotting studies. Blood biochemistry revealed azotemia in all cases, hyponatremia in 5 cases, hypernatremia in 3 cases and hyperkalemia in 12 cases. Stool culture showed the presence of Shigella in 8, E. coli in 6 and Klebsiella in 4 cases. Out of 22 cases of HUS, 15 were treated conservatively; of these 2 died. Both of these deaths were due to DIC 7 children were put on peritoneal dialysis; only 1 child died in this group. Factors affecting the outcome were duration of oliguria, levels of blood urea and presence of encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A clinico-hematological profile of hemolytic-uremic syndrome. 788 99

A 46-year-old woman who noticed tightness of the skin in September, 1993, was admitted to a local hospital due to hypertension, congestive heart failure and renal dysfunction on the 2nd of November. After admission, renal function deteriorated progressively. A diagnosis of scleroderma renal crisis (SRC) was suspected from her skin biopsy and clinical course. She was referred to our hospital for further evaluation and maintenance of hemodialysis. Her blood pressure was kept normal by anti-hypertensive drugs including cilazapril. Acute interstitial pneumonia, microangiopathic hemolytic anemia and thrombocytopenia appeared during her clinical course. Corticosteroid therapy was effective for acute interstitial pneumonia, but in-effective for thrombocytopenia. Plasma exchange was not effective for thrombocytopenia, which was successfully treated with intravenous gamma-globulin therapy. She died of cytomegaloviral encephalitis, which might have resulted from immunodeficiency caused by prolonged corticosteroid therapy and uremia. Complications other than SRC might have appeared during the clinical course based on the immune disorder of progressive systemic sclerosis itself. In order to improve the prognosis of patients with SRC such complications should be detected promptly and treated correctly.
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PMID:[A case of scleroderma renal crisis with acute interstitial pneumonia, microangiopathic hemolytic anemia and refractory thrombocytopenia]. 796 79

A 63-year-old woman was in hospital for persistent backache. Four months prior to admission she had been pointed out as having hypertension for the first time. On admission, she had anemia (hemoglobin 7.0 g/dl) with reticulocytosis, and a blood smear showed fragmented erythrocytes. A bone marrow aspirate disclosed erythroid hyperplasia and invasion of cancer cells. The chest roentgenogram showed a coin-lesion of the right lung and left pleural effusion. A diagnosis of microangiopathic hemolytic anemia (MAHA) associated with carcinomatosis was made, but the primary site of the cancer was unknown. Respiratory failure developed and the patient died a month later. Surprisingly, the autopsy revealed a malignant pheochromocytoma arising from the right adrenal gland with massive metastases to the lungs, liver, lymph nodes and systemic bones, and also disseminated intravascular coagulation (DIC). The DIC would probably account for the MAHA in this case. To our knowledge, this is the first reported case of malignant pheochromocytoma accompanied by MAHA.
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PMID:Malignant pheochromocytoma accompanied by microangiopathic hemolytic anemia: a case report. 800 27

We report a patient with mixed connective tissue disease who developed accelerated hypertension, acute renal insufficiency, and microangiopathic hemolytic anemia. A renal biopsy specimen showed marked vascular changes in small arteries consisting of laminated endothelial cell proliferation and luminal thrombosis, which were similar to those of scleroderma renal crisis. This patient was successfully treated with an angiotensin-converting enzyme inhibitor as well as analogues of prostaglandin E1 and prostaglandin I2. In patients with mixed connective tissue disease, a fatal complication like scleroderma renal crisis should be considered when the blood pressure rapidly increases. The combined administration of angiotensin-converting enzyme inhibitors and analogues of prostaglandin E1 and prostaglandin I2 may be an effective treatment for this complication.
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PMID:Sclerodermatous renal crisis in a patient with mixed connective tissue disease. 804 28

The Authors describe a case of immuno-hemolytic anemia in a 67-year-old woman with hypertension who had been treated irregularly with lisinopril for three months. The hemolytic crisis resolved promptly after withdrawal of lisinopril and did not recur under high-dose methylprednisolone therapy.
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PMID:[Immuno-hemolytic anemia associated with lisinopril therapy. Report of a case]. 839 98

Hemolytic uremic syndrome associated with pregnancy is a rare condition. Authors report a patient treated with corticosteroids for bronchial asthma who was afflicted by placental abruption at 24 weeks' gestation. The abruption was preceded by developing herpes zoster and by deteriorating respiratory symptoms. The induced labor was followed by anuria, acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia then fever and hypertension. The patient was treated early with plasma infusion, transfusion and hemodialysis. She recovered completely after 7 weeks. This case seems to be unique inasmuch as the hemolytic uremic syndrome was preceded by prodromal illness during pregnancy and was associated with placental abruption.
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PMID:Postpartum hemolytic uremic syndrome following placental abruption. 840 36

The hemolytic-uremic syndrome (HUS) is an acute disorder, characterized by the triad of microangiopathic hemolytic anemia, nephropathy and thrombocytopenia. The great majority of patients are children, usually under 4 years of age, although adults can be affected. The onset is abrupt and usually follows gastroenteritis or upper respiratory infection. Later, clinical manifestations based on the triad, such as pallor, jaundice, edema, hypertension and purpura soon develop. The urinary output is reduced and the urine may appear dark yellow or tea-colored. Laboratory tests of peripheral blood show severe hemolytic anemia associated with fragmented red blood cells and thrombocytopenia, usually below 50,000/microliters. The blood urea nitrogen, serum creatinine and lactate dehydrogenase concentrations are elevated. Proteinuria and microscopic hematuria, which are indicative of active glomerular damage are also seen. Profound understanding of these manifestations is sufficient to permit an early diagnosis of HUS.
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PMID:[Diagnosis and clinical features of hemolytic uremic syndrome]. 843 21

Thus I would like to conclude by saying that an idiopathic form of obliterative renal arteriopathy account for the rare presentation of severe hypertension and progressive renal failure with or without overt hemolytic anemia and thrombocytopenia in children. It can be labelled as primary malignant nephrosclerosis (NScl) or atypical HUS, based on primary thrombotic angiopathy. This, essentially intimal changes, is seen in diverse conditions and appears to result from primary endothelial injury followed by intimal exudation, thrombosis, and repair by fibrosis. Persistent or recurrence of this process form the basis of progressive obliterative arteriopathy. The result is renal ischemia and renin-angiotensin mediated hypertension. Establishment of a vicious circle would further accelerate HT and lead to end stage renal failure. Early recognition and prompt therapeutic intervention might prove beneficial.
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PMID:Thrombotic microangiopathy with hypertension and acute renal failure in children (a typical hemolytic uremic syndrome). 869 75

In 1982 Weinstein coined the term HELLP syndrome to describe a special group of pre-eclamptic women who had evidence of hemolysis, elevated liver enzymes and low platelets. The question of whether the HELLP syndrome exists as a distinct entity or is a part of a spectrum of pregnancy complications has long been a source of speculation and debate among obstetricians and internists. A review of the literature indicates that the syndrome occurs in post-partum from 20% to 30% of the cases; maternal mortality from 1% to 4% and perinatal mortality from 5% to 40%. Hypertension and proteinuria are frequently associated with HELLP syndrome, but may also be absent. The syndrome is a group of clinical and pathological manifestations resulting from an insult that leads to intravascular platelet activation (thrombocytopenia) and micro-angiopathic hemolytic anemia (elevated total bilirubin and LDH). Endothelial damage and vasospasm are responsible of hepatic hypoperfusion that results in liver damage, as indicated by a rise in circulating liver enzymes. Since natural evolution of HELLP syndrome is the disseminated intravascular coagulation (CID), the interruption of pregnancy is mandatory and irrespective of the gestational age. This is the reason of an high incidence of cesarean section. Visser and Wallemburg (1995) treated 128 pre-eclamptic patients with HELLP syndrome with volume expansion and pharmacologic vasodilatation under invasive haemodynamic monitoring; they tried to delay delivery with the aim of enhancing fetal maturity. A complete reversal of HELLP occurred in 43% of patients. Further investigations will be necessary to confirm this interesting experience.
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PMID:[The HELLP syndrome. Notes on its pathogenesis and treatment]. 876 57

On June 29, 1995, a 49-year-old man was admitted with acute onset of fever, petechiae on his legs, and mental confusion He had suffered hypertension since 6 months previously and was on nicardipine (60 mg/day), ifenprodil (60 mg/day) and ticlopidine (300 mg/day). He had been on ticlopidine for 4 weeks and on the other drugs for 6 months. Soon after admission he had frequent grand mal seizures and needed mechanical ventilation. A diagnosis of TTP was made. He was treated with plasmapheresis (50 ml/kg per day), aspirin 81 mg/day and dipyridamole 300 mg/day. On the sixth day his mental status returned to normal. He recovered gradually from microangiopathic hemolytic anemia, thrombocytopenia and elevated serum creatinine. We reviewed the literature and discussed the possible mechanism of TTP related to the use of ticlopidine.
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PMID:[Thrombotic thrombocytopenic purpura after administration of ticlopidine]. 896 Jun 74


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