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A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency

A 26-year-old man presented to the emergency room with abdominal pain, nausea, and vomiting for four days. His medical history was significant for hypertension and end-stage renal disease managed with hemodialysis. He had been noncompliant with the antihypertensive regimen which included nifedipine,...

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Autores principales: Ali, Farman, Ullah, Aman, Amjad, Waseem, Kochar, Tanureet, Annie, Frank H, Farooq, Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207490/
https://www.ncbi.nlm.nih.gov/pubmed/30410841
http://dx.doi.org/10.7759/cureus.3235
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author Ali, Farman
Ullah, Aman
Amjad, Waseem
Kochar, Tanureet
Annie, Frank H
Farooq, Ali
author_facet Ali, Farman
Ullah, Aman
Amjad, Waseem
Kochar, Tanureet
Annie, Frank H
Farooq, Ali
author_sort Ali, Farman
collection PubMed
description A 26-year-old man presented to the emergency room with abdominal pain, nausea, and vomiting for four days. His medical history was significant for hypertension and end-stage renal disease managed with hemodialysis. He had been noncompliant with the antihypertensive regimen which included nifedipine, hydralazine, and spironolactone. At presentation, his blood pressure was 231/123 mmHg. Laboratory workup showed white blood count 17.3 × 109/L (normal range: 4.5 to 11.0 × 109/L), hemoglobin 7.8 gm/dL (normal range: 13.5 to 17.5 g/dL), platelet count 46 × 109/L (normal range: 150 to 400 × 109/L), reticulocyte count 7.8%, total bilirubin 1 mg/dL (normal range: 0.1 to 1.2 mg/dL), lactate dehydrogenase 1,235 U/L (normal range: 140 to 280 U/L), haptoglobin < 10 mg/dL, and a direct Coomb's test was negative. Numerous schistocytes were identified on the peripheral blood smear. The patient was diagnosed with thrombotic microangiopathy secondary to severe hypertension and was started on intravenous nicardipine. With appropriate blood pressure control, hematological parameters improved with normalization of the platelet count within 10 days. Notably, the patient had one similar episode of hypertension-induced thrombotic microangiopathy within a period of the last three months and ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type 1 motif 13) activity was normal on his previous admission.
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spelling pubmed-62074902018-11-08 A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency Ali, Farman Ullah, Aman Amjad, Waseem Kochar, Tanureet Annie, Frank H Farooq, Ali Cureus Cardiology A 26-year-old man presented to the emergency room with abdominal pain, nausea, and vomiting for four days. His medical history was significant for hypertension and end-stage renal disease managed with hemodialysis. He had been noncompliant with the antihypertensive regimen which included nifedipine, hydralazine, and spironolactone. At presentation, his blood pressure was 231/123 mmHg. Laboratory workup showed white blood count 17.3 × 109/L (normal range: 4.5 to 11.0 × 109/L), hemoglobin 7.8 gm/dL (normal range: 13.5 to 17.5 g/dL), platelet count 46 × 109/L (normal range: 150 to 400 × 109/L), reticulocyte count 7.8%, total bilirubin 1 mg/dL (normal range: 0.1 to 1.2 mg/dL), lactate dehydrogenase 1,235 U/L (normal range: 140 to 280 U/L), haptoglobin < 10 mg/dL, and a direct Coomb's test was negative. Numerous schistocytes were identified on the peripheral blood smear. The patient was diagnosed with thrombotic microangiopathy secondary to severe hypertension and was started on intravenous nicardipine. With appropriate blood pressure control, hematological parameters improved with normalization of the platelet count within 10 days. Notably, the patient had one similar episode of hypertension-induced thrombotic microangiopathy within a period of the last three months and ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type 1 motif 13) activity was normal on his previous admission. Cureus 2018-08-30 /pmc/articles/PMC6207490/ /pubmed/30410841 http://dx.doi.org/10.7759/cureus.3235 Text en Copyright © 2018, Ali et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Ali, Farman
Ullah, Aman
Amjad, Waseem
Kochar, Tanureet
Annie, Frank H
Farooq, Ali
A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency
title A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency
title_full A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency
title_fullStr A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency
title_full_unstemmed A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency
title_short A Case of Recurrent Thrombotic Microangiopathy Caused by Hypertensive Urgency
title_sort case of recurrent thrombotic microangiopathy caused by hypertensive urgency
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207490/
https://www.ncbi.nlm.nih.gov/pubmed/30410841
http://dx.doi.org/10.7759/cureus.3235
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