title: A rare case of malignant-phase hypertension with pulmonary alveolar hemorrhage.
abstract: Malignant-phase hypertension is characterized clinically by severe accelerating hypertension with neuroretinopathy or papilledema and by evidence of renal damage. A Japanese male in his early thirties presented with hemoptysis and general fatigue. He had a 5-year history of hypertension, but had not received any treatment. His blood pressure was 290/150 mmHg and his serum creatinine level was 8.24 mg/dL. Chest X-rays and computed tomography scans of the chest revealed a pulmonary alveolar hemorrhage. He was suspected of having vasculitis syndrome or Goodpasture's syndrome, but his renal biopsy specimen showed malignant nephrosclerosis. Myeloperoxidase antineutrophil cytoplasmic antibody (ANCA), proteinase-3 ANCA and antiglomerular basement membrane antibody were negative. He was treated with a calcium antagonist and a β-blocker, followed by an angiotensin-converting enzyme inhibitor. After the administration of the β-blocker, his blood pressure decreased and his renal function gradually improved. This is a rare case of malignant-phase hypertension with pulmonary alveolar hemorrhage; this condition should be considered in the differential diagnosis in order to avoid unnecessary treatment such as immunosuppressive therapy.
authors.affiliation: Department of Nephrology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Nanba
authors.forename: Kensei
authors.initials: K
authors.lastname: Yahata
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Chinatsu
authors.initials: C
authors.lastname: Okamoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Seta
authors.forename: Akira
authors.initials: A
authors.lastname: Sugawara
mesh_terms: D000328:Adult; D019867:Anti-Glomerular Basement Membrane Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D006470:Hemorrhage / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006974:Hypertension, Malignant / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D011650:Pulmonary Alveoli