Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 22-year-old primipara presented with hypertension, anemia, thrombocytopenia and elevated liver enzymes. She was initially managed as a case of HELLP syndrome but, with conventional treatment, the expected improvement did not occur. She later developed intractable oliguria and azotemia. The importance of considering hemolytic uremic syndrome, a distinct part of the spectrum of preeclampsia, separate from but overlapping with HELLP syndrome, was discussed. The need for vigilance in the management was emphasized since the definitive treatment and prognosis differ greatly between the two conditions.
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PMID:Hemolytic uremic syndrome in pregnancy. 1217 64

Results of different studies conducted over the past 2 decades on the relationship between oral contraceptive (OC) use and venous thromboembolism, stroke, and myocardial infarct are summarized. The possibility that OCs would increase the risk of venous thrombosis was 1st raised by a case reported in 1961, and has been confirmed by at least 9 retrospective and 4 prospective studies in the UK, US, and Scandinavia. An increased risk of venous thrombosis has been confirmed only among women currently using OCs and possibly among those stopping use within 1-2 weeks. The risk is unrelated to duration of use, although few data are available on women using OCs continuously for more than 3 years. The proof of a relationship between risk of venous thrombosis and estrogen content is convincing, although an association with progestin content has also been suggested. Evidence is beginning to accumulate for an association between smoking and venous thrombosis in OC users and nonusers alike. British prospective studies have indicated a risk of death from venous thrombosis in OC users of 2-3/100,000 users/year during the 1970s, but modern low-dose formulations, better patient selection, and better surveillance have probably reduced the risk further. The evidence of a relationship between OC use and cerebral hemorrhage is only moderately convincing, with any increased risk unlikely to be more than 2-fold. The data regarding cerebral thrombosis are more consistent and convincing; they demonstrate a positive association of risk of cerebral thrombosis with both the estrogen and progestin content of OCs. Past as well as current users may be at increased risk, but data on the effect of duration of use are lacking. At least 9 retrospective and 2 prospective studies have established the significance of the risk of myocardial infarct in OC users. Risk of myocardial infarct may be related to both estrogen and progestin content, and appears to be limited to current users. Little evidence has been found of a relationship to duration of use. Strong evidence exists of a relationship between OC use and other risk factors for myocardial infarct, including smoking and hypertension. Very few deaths were observed from this cause in women under 35 in the 1970s. As with venous thrombosis, the mortality risks of stroke and myocardial infarct have probably declined appreciably in the past few years. OCs have been implicated in blood pressure elevations as well as a series of cardiovascular problems such as Budd-Chiari syndrome, occlusion of arteries in the intestines and extremities, and hemolytic uremic syndrome. The few available published studies suggest that administration of estrogens to peri- or postmenopausal women does not entail a cardiovascular risk.
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PMID:[Vascular disease and hormonal treatment--epidemiology]. 1228 Jan 97

We describe a 71-year-old man, who had been treated for hypertension, myocardial infarction and abdominal aortic aneurysm, and was admitted to our hospital because of proteinuria(3.9 g/day at the outpatient clinic and 1.5 g/day at the time of admission) and edema in the extremities. Light microscopic study of the kidney biopsy specimen revealed mesangial proliferative glomerulonephritis and glomerular paralysis. Electron microscopic findings showed endothelial damage, including widening of the subendothelial space and detachment of endothelial cells from the glomerular basement membrane. Deposition of immunoglobulins and complement was not detected by immunofluorescence studies. These pathological findings resemble the findings of thrombotic microangiopathy, but there were no clinical pictures of HUS/TTP. These findings suggest that hypertension, atherosclerosis and circulating turbulence caused by an aortic aneurysm induced severe glomerular endothelial damage leading to mesangial proliferative glomerulonephritis without an immune response.
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PMID:[A case of mesangial proliferative glomerulonephritis with endothelial damage]. 1247 92

Postpartum hemolytic uremic syndrome (HUS) is an unusual complication that presents with microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure after delivery. In this report, we describe a 32-year-old patient (gravida 3, para 1, artificial abortion 1) who developed postpartum HUS following abruptio placenta. After cesarean delivery due to abruptio placenta, the patient developed acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia followed by hypertension. Plasma exchange led to recovery from thrombocytopenia and improvement in renal function. This case highlights the importance of observation of peripheral blood smears in patients with abruptio placenta who develop thrombocytopenia after delivery.
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PMID:Postpartum hemolytic uremic syndrome following abruptio placenta: report of a case. 1263 22

Invasive bacterial and candidal infections are known to involve the retina, but the natural history of the retinal lesions and the utility of ophthalmologic consultation in the critical care setting as a diagnostic tool are not well understood. We 1) performed weekly funduscopic examinations on 77 medical and surgical patients in intensive care units (ICUs), 2) analyzed results of serial ocular examinations in 180 non-neutropenic patients with candidemia, and 3) reviewed the English literature on the association of retinal lesions with disseminated bacterial or candidal infection (DBCI). We found that 15 (19%) of the ICU patients had retinal lesions consistent with DBCI. Of these 15, 1 had clearly sepsis-related retinal lesions, while 13 (87%) had 1 or more systemic disease that could have explained their retinal findings (6 diabetic retinopathy; 2 human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) retinopathy; 2 hypertensive retinopathy; 1 hemolytic uremic syndrome, and 1 leukemia). Multivariate analysis revealed that systemic disease (odds ratio 8.37, 95% confidence intervals: 3.24-21.56) independently correlated with the presence of retinal lesions while DBCI, trauma, hyperalimentation, and transfusion of blood products were not independently predictive in any analysis. Twenty of the 180 (15%) candidemic patients had retinal lesions. Two (1%) had classic 3-dimensional white lesions with vitreal extension, and 5 (2.7%) had chorioretinal lesions without vitreal haziness. Notably, 10% of patients had superficial retinal hemorrhages and/or cotton wool spots that could have been due to either candidemia or a systemic disease (diabetes, hypertension, renal failure, closed head trauma). Concurrent bacteremia occurred in 3 of the 27 patients with eye lesions. Retinal lesions resolved in a mean of 33 days. None of the patients had symptoms at the time of the retinal finding. We found 3 studies that prospectively assessed retinal lesions in bacteremic patients. The frequency of retinal lesions in these series varied from 12% to 26%, with the most common lesions being cotton wool spots followed by superficial retinal hemorrhages. White-centered hemorrhages were seen in about 15% +/- 2 of bacteremic patients. Five studies prospectively evaluated candidemic patients for Candida endophthalmitis. These studies observed rates from 0% to 78% for lesions consistent with candidal endophthalmitis. Most studies performed recently found that nonspecific lesions such as cotton wool spots or superficial retinal hemorrhages occurred with a frequency of 11% to 20%. The availability of less toxic antifungal agents, more frequent use of empirical therapy, and the trend to early treatment may be altering the frequency of this complication. Observation of a classic 3-dimensional retina-based vitreal inflammatory process is virtually diagnostic of endogenous endophthalmitis due to Candida spp., but such lesions are relatively uncommon. Conversely, nonspecific lesions that could be due to bacterial or candidal endophthalmitis (cotton wool spots, retinal hemorrhages, and Roth spots) are seen frequently. These lesions are most often due to an underlying systemic disease rather than an infection. Serial examinations provide the best evidence that a given lesion is due to an intercurrent infection. The current low rate of vitreal extension of retinal process appears to be due to the high rate of empirical or therapeutic use of antifungal agents in high-risk patient groups. Ophthalmoscopy should be performed in patients with known candidemia. However, ophthalmoscopic examination seems to have little value in assisting with the discovery of occult disseminated candidiasis or bacterial infection.
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PMID:Retinal lesions as clues to disseminated bacterial and candidal infections: frequency, natural history, and etiology. 1279 5

We report on a 61-year-old woman with chronic myeloid leukemia (CML) who developed a hemolytic uremic syndrome (HUS)-like episode following nonmyeloablative allogeneic hematopoietic stem cell transplantation. Macrohematuria, hypertension, hemolytic anemia with red cell fragmentation, thrombocytopenia, and progressive renal insufficiency were observed after thawed peripheral blood stem cell (PBSC) infusion. Although transient systemic hemolysis is known to occur during dimethylsulfoxide (DMSO)-cryopreserved stem cell infusion, HUS caused by DMSO has not been described in the literature. We speculate that one of the triggers of the HUS-like episode could have been renal microangiopathy caused by the long-term administration of interferon-alpha before the stem cell transplantation.
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PMID:[Hemolytic uremic syndrome-like episode following nonmyeloablative hematopoietic stem cell transplantation in a patient with chronic myeloid leukemia]. 1288 18

A four-year old boy was admitted to the hospital due to acute thrombocytopenic purpura. Three days later he developed edema, hematuria and hypertension. The diagnosis of acute poststreptococcal glomerulonephritis was based upon the evidence of previous sore throat, hypocomplementemia and increased antistreptolysin O titer. Renal biopsy was contraindicated due to throbocytopenia. An extensive work-up was done to exclude mebranoproliferative glomerulonephritis and systemic diseases such as hemolytic uremic syndrome or systemic lupus erythematosus. The clinical outcome of the nephritis and thrombocytopenia was excellent in respect to both conditions. To the best of our knowledge concurrent occurrence of acute thrombocytopenic purpura and poststreptococcal glomerulonephritis is very rare; there are only four similar cases reported in the literature. A careful work-up and follow-up are mandatory to exclude systemic disease.
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PMID:Thrombocytopenia during the course of acute poststreptococcal glomerulonephritis. 1292 3

Five patients with severe hemolytic uremic syndrome (HUS) were followed for 10-18 years. Because of proteinuria, arterial hypertension, and reduced glomerular filtration rates, they received either captopril (n=2) or enalapril (n=3), or both (n=1) for 8-15 years. Blood pressure was normalized and proteinuria reduced in all; glomerular filtration improved in three patients and fell moderately in two. Four of the five patients have reached adult age with body weight and height, blood pressure, and serum creatinine levels within the normal range. At the last evaluation, median proteinuria was 220 mg/24 h (range 0-310) and glomerular filtration rate 56 ml/min per 1.73 m(2)(range 40-127). This long-term study indicates a renoprotective effect of angiotensin-converting enzyme inhibitors in patients with sequelae after HUS.
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PMID:Renoprotection by ACE inhibitors after severe hemolytic uremic syndrome. 1506 39

The hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure (ARF) in young children. Most patients recover from the acute phase of the illness but they may develop arterial hypertension(AH) after many years, even in the absence of signs of renal impairment during short-term follow-up. In this study, we performed casual blood pressure (BP) measurement, 24-h blood pressure monitoring (ABPM), and a Bruce walking treadmill study (ET) in 24 children (aged 5-15 years, 13 males, 11 females) with a history of HUS and normal renal function during follow-up (median 5.8 years, range 1.8-12.4 years). There were 22 children(91%) with prodromal diarrhea associated with HUS and 20 (83%) underwent dialysis during the acute illness. All children had normal casual BP measurement. Of 13 children (54%) with normal ABPM, 5 patients (38%) had an abnormal BP response during the ET study. There were 4 (58%) of the 7 patients with AH by ABPM (29%)and an abnormal BP response during ET. These findings suggest that ET could be a useful means of identifying children with a history of HUS that could be at risk of future AH even if they had normal renal function, casual BP, and ABPM during long-term follow-up. These results should be confirmed with a large prospective clinical study.
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PMID:Blood pressure in the long-term follow-up of children with hemolytic uremic syndrome. 1578 9

We conducted prospective surveillance of childhood hemolytic uremic syndrome (HUS) from 1997 to 2001 to describe disease incidence and clinical, epidemiologic and microbiologic characteristics. We compared our findings, where possible, with those of a previous study conducted from 1985 to 1988. The average annual incidence of HUS for the United Kingdom and Ireland (0.71/100,000) was unchanged from 1985 to 1988. The overall early mortality had halved, but the reduction in mortality was almost entirely accounted for by improved outcome in patients with diarrhea-associated HUS. The principal infective cause of diarrhea-associated HUS was Shiga toxin-producing Escherichia coli O157 (STEC O157), although in the 1997-2001 survey STEC O157 phage type (PT) 21/28 had replaced STEC O157 PT2 as the predominant PT. The risk of developing diarrhea-associated HUS was significantly higher in children infected with STEC O157 PT 2 and PT 21/28 compared with other PTs. Hypertension as a complication of HUS was greatly reduced in patients with diarrhea-associated HUS.
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PMID:Childhood hemolytic uremic syndrome, United Kingdom and Ireland. 1582 99


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