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

BMJ 2007; 335 doi: (Published 26 July 2007) Cite this as: BMJ 2007;335:205
  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
  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}
  • Accepted 2 April 2007

Four weeks ago we described the case of a 46 year old woman who presented with possible miscarriage, severe hypertension, acute renal failure, pulmonary oedema, microangiopathic haemolytic anaemia, and seizures (BMJ 2007;334:1372, doi: 10.1136/bmj.39212.564745.BE). The diagnoses we considered were malignant hypertension, intrinsic renal disease, a primary microangiopathic process—such as haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura, or eclampsia with HELLP syndrome. She was started on intermittent haemodialysis, an angiotensin converting enzyme inhibitor, and plasma exchange (BMJ 2007;335:44, doi: 10.1136/bmj.39239.478495.80). A magnetic resonance imaging scan of the brain showed posterior leucoencephalopathy consistent with hypertensive encephalopathy.

Her platelet count, metabolic abnormalities, and breathlessness improved and she had no further seizures. At one week she was well …

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