A patient with suspected miscarriage is found to have hypertension, renal failure, and thrombocytopenia: case outcome

doi:10.1136/bmj.39239.479560.80

BMJ 2007;335:205-206 (28 July), doi:10.1136/bmj.39239.479560.80

Practice

Interactive case report

A patient with suspected miscarriage is found to have hypertension, renal failure, and thrombocytopenia: case outcome

Chris M Laing, specialist registrar in nephrology¹, Rhys Roberts, senior house officer in medicine², Liz Lightstone, consultant nephrologist¹, Alison Graham, consultant radiologist³, Terry H Cook, professor of renal pathology⁴, Shaun Summers, specalist registrar in nephrology and internal medicine¹, Charles D Pusey, professor of medicine⁵

¹ West London Renal and Transplant Centre, Hammersmith Hospital, London W12 0HS, ² Department of Medicine, Hammersmith Hospital, ³ Department of Radiology, Hammersmith Hospital, ⁴ Division of Investigative Science, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, ⁵ Division of Medicine, Imperial College London, Hammersmith Hospital Campus

Correspondence to: Chris M Laing christopher.laing@mac.com

The first 150 words of the full text of this article appear below.

Four weeks ago we described the case of a 46 year old womanwho presented with possible miscarriage, severe hypertension,acute renal failure, pulmonary oedema, microangiopathic haemolyticanaemia, and seizures (BMJ 2007;334:1372, doi: 10.1136/bmj.39212.564745.BE).The diagnoses we considered were malignant hypertension, intrinsicrenal disease, a primary microangiopathic process—suchas haemolytic uraemic syndrome or thrombotic thrombocytopenicpurpura, or eclampsia with HELLP syndrome. She was started onintermittent haemodialysis, an angiotensin converting enzymeinhibitor, and plasma exchange (BMJ 2007;335:44, doi: 10.1136/bmj.39239.478495.80).A magnetic resonance imaging scan of the brain showed posteriorleucoencephalopathy consistent with hypertensive encephalopathy.

Her platelet count, metabolic abnormalities, and breathlessnessimproved and she had no further seizures. At one week she waswell but remained dependent on dialysis. Bisoprolol and amlodipinewere added to control her blood pressure.

Renal Doppler ultrasound showed poor renal perfusion so we performedangiography to exclude renovascular disease. This showed . . . [Full text of this article]

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Commentary: Nephrologist: Robin Woolfson
BMJ 2007 335: 206-207. [Extract] [Full Text] [PDF]

Commentary: View from clinical education: Ed Peile
BMJ 2007 335: 207-208. [Extract] [Full Text] [PDF]

Commentary: Author's reply: Chris M Laing
BMJ 2007 335: 208. [Extract] [Full Text] [PDF]

A patient with suspected miscarriage is found to have hypertension, renal failure, and thrombocytopenia: case progression: Chris M Laing, Rhys Roberts, Liz Lightstone, Alison Graham, Terry H Cook, Shaun Summers, and Charles D Pusey
BMJ 2007 335: 44. [Extract] [Full Text] [PDF]

A patient with suspected miscarriage is found to have hypertension, renal failure, and thrombocytopenia: case presentation: Chris M Laing, Rhys Roberts, Liz Lightstone, Alison Graham, Terry H Cook, Shaun Summers, and Charles D Pusey
BMJ 2007 334: 1372. [Extract] [Full Text] [PDF]

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