title: Acute renal failure and severe hypertension in children with renal thrombotic microangiopathy.
abstract: We observed 12 boys and 1 girl, 5-15 years old, presenting with acute renal failure (ARF) and severe hypertension. They constituted 4.9% of all patients with ARF. There was no preceding diarrheal or respiratory prodrome. Clinical and laboratory findings were indicative of hemolytic uremic syndrome (HUS) in 4, but obscure in 9 others. Renal biopsies revealed variably severe occlusive thrombotic microangiopathy (TMA) affecting predominantly interlobular arteries in 8 and both arteries and glomeruli in 5 cases. Glomerular crescents and cortical necrosis were not seen. Following supportive therapy, 8 progressed to or died of uremia; 2 showed persistent proteinuria, 1 moderate hypertension and 2 complete recovery. Our observations indicate that renal TMA without a prodromal illness and typical features of HUS may present with ARF, proteinuria and severe hypertension, and is associated with high mortality.
authors.affiliation: Department of Pathology, All-India Institute of Medical Sciences, New Delhi.
authors.forename: U N
authors.initials: UN
authors.lastname: Bhuyan
authors.forename: A
authors.initials: A
authors.lastname: Bagga
authors.forename: R N
authors.initials: RN
authors.lastname: Srivastava
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications* / Q000628:therapy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005455:Fluorescent Antibody Technique; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006977:Hypertension, Renal / Q000097:blood / Q000150:complications* / Q000628:therapy; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008833:Microcirculation / Q000473:pathology; D013927:Thrombosis / Q000150:complications*
chemical_list: D006454:Hemoglobins; D007070:Immunoglobulin A; D007074:Immunoglobulin G