title: [Hypertensive emergency with clinical signs of a thrombotic microangiopathy].
abstract: METHODS
  A 38-year-old woman presented with strong headache, abdominal and chest pain. Blood pressure was 240/115 mmHg. In the emergency room lab troponin T was elevated. Further tests showed signs of hemolysis and thrombopenia. In addition kidney failure was present.
  
  
  METHODS
  The ECG showed tachycardia, but no other changes. Echocardiography revealed hypertrophy of the left ventricle. In the eye exam hypertensive retinopathy was demonstrated. Kidney biopsy showed signs compatible with malignant hypertension.
  
  
  METHODS
  Due to chest pain and elevation of troponin T acute coronary syndrome was diagnosed. In combination with thrombopenia and hemolysis a thrombotic microangiopathy was suspected. Because of the hypertensive emergency malignant hypertension became a possible differential diagnosis. Unfortunately antiplatelet treatment precluded kidney biopsy right at the beginning. Thus, plasmapheresis was initiated together with antihypertensive treatment. Kidney biopsy was done after plasma exchange and confirmed the diagnosis of malignant hypertension.
  
  
  CONCLUSIONS
  Diagnosis of malignant hypertension can be difficult because symptoms of thrombotic microangiopathy are frequently present. In many cases only the combination of history, exams of endorgan damage and clinical course is needed to confirm the diagnosis. Prompt and sustained lowering of the blood pressure is pivotal. Even after successful treatment patients keep an elevated cardiovascular risk and need a close follow up.
authors.affiliation: Klinik für Nephrologie, Universitätsklinik der Heinrich-Heine Universität Düsseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schauseil
authors.forename: L C
authors.initials: LC
authors.lastname: Rump
authors.forename: I
authors.initials: I
authors.lastname: Quack
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001706:Biopsy; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006801:Humans; D006974:Hypertension, Malignant / Q000175:diagnosis* / Q000628:therapy; D006977:Hypertension, Renal / Q000175:diagnosis / Q000473:pathology; D007668:Kidney / Q000473:pathology; D009393:Nephritis / Q000175:diagnosis / Q000473:pathology; D009400:Nephrosclerosis / Q000175:diagnosis / Q000628:therapy; D010951:Plasma Exchange; D010956:Plasmapheresis; D010976:Platelet Count; D051437:Renal Insufficiency / Q000175:diagnosis; D017582:Renal Replacement Therapy; D013921:Thrombocytopenia / Q000175:diagnosis* / Q000628:therapy; D057049:Thrombotic Microangiopathies / Q000175:diagnosis* / Q000628:therapy; D020107:Troponin T / Q000097:blood
chemical_list: D000959:Antihypertensive Agents; D020107:Troponin T