BMJ  2007;335:208 (28 July), doi:10.1136/bmj.39280.407975.BE

Practice

Commentary: Author's reply

West London Renal and Transplant Centre, Hammersmith Hospital, London W12 0HS

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

We hope that readers have found this interactive case report interesting and educational. The rapid responses—from many countries, specialties, and grades—have been informative. We would like to thank BMJ readers for taking such an interest in the case and taking time to post their responses.

This patient presented with scleroderma renal crisis and features typical of accelerated hypertension—acute renal failure, pulmonary oedema, microangiopathic haemolysis, and hypertensive encephalopathy.

We agree with many responders that investigation for recurrent miscarriage was not necessary on the basis of the reproductive history alone, but that other features of her illness certainly warranted investigation. Investigation of accelerated hypertension may include endocrine testing, renovascular studies, serology, and renal biopsy. In our experience, white patients with this presentation often have an underlying cause.

As regards her management, basic resuscitation, adequate monitoring, and safe and timely transfer to a specialist unit were crucial. We used nitrates for pressure control . . . [Full text of this article]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Article

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

Chris M Laing, Rhys Roberts, Liz Lightstone, Alison Graham, Terry H Cook, Shaun Summers, and Charles D Pusey
BMJ 2007 335: 205-206. [Extract] [Full Text] [PDF]