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Interactive case report

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

BMJ 2007; 335 doi: 10.1136/bmj.39239.478495.80 (Published 5 July 2007)
Cite this as: BMJ 2007;335:44

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  1. Chris M Laing, specialist registrar in nephrology1,
  2. Rhys Roberts, senior house officer in medicine2,
  3. Liz Lightstone, consultant nephrologist1,
  4. Alison Graham, consultant radiologist3,
  5. Terry H Cook, professor of renal pathology4,
  6. Shaun Summers, specalist registrar in nephrology and internal medicine1,
  7. Charles D Pusey, professor of medicine5
  1. 1West London Renal and Transplant Centre, Hammersmith Hospital, London W12 0HS
  2. 2Department of Medicine, Hammersmith Hospital, London W12 0HS
  3. 3Department of Radiology, Hammersmith Hospital
  4. 4Division of Investigative Science, Imperial College London, Hammersmith Hospital Campus, London W12 0NN
  5. 5Division of Medicine, Imperial College London, Hammersmith Hospital Campus
  1. 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 …

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