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

doi:10.1136/bmj.39239.478495.80

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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

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

Correspondence to: Chris M Laing christopher.laing{at}mac.com

Accepted 2 April 2007

Last week (30 June; doi: 10.1136/bmj.39212.564745.BE) we described the case of a 46 year old woman who presented after a possible miscarriage with severe hypertension, acute renal failure, alveolar infiltrates on chest radiography, thrombocytopenia, and grand mal convulsions.

Initially, she was given an intravenous infusion of lorazepam, frusemide, and a nitrate. A computed tomography scan of the brain excluded acute haemorrhage. She was then transferred to the renal unit of the Hammersmith Hospital.

On arrival, she remained severely hypertensive at 200/120 mm Hg. Fundoscopy demonstrated flame haemorrhages and papillo-oedema. She had severe peripheral and pulmonary oedema. Urine microscopy demonstrated red blood cells but no red cell casts. Her haemoglobin continued to fall …