Objective To investigate the clinical and pathological characteristics of lupus nephritis patients complicated with malignant hypertension.Methods We retrospectively studied 19 patients with lupus nephritis complicate...Objective To investigate the clinical and pathological characteristics of lupus nephritis patients complicated with malignant hypertension.Methods We retrospectively studied 19 patients with lupus nephritis complicated with malignant hypertension who underwent renal biopsy between January 2002 and December 2006.Results Of 19 patients,3 were men and 16 were women,with a mean age of 24.4±7.7 years old.All had positive antinuclear antibodies and low serum complement was found in 13 patients.All were anemic and 12 of them were thrombocytopenic.Impaired renal function was found in 17 patients with an average serum creatinine of 184.5±88.9 μmol/L.Severe intrarenal arteriolar lesion was found in all patients.Six patients had lupus vasculopathy,11 patients had renal thrombotic microangiopathy lesion,2 had severe arteriosclerosis.All patients received steroids and immunosuppressive drugs,15 received angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)with resultant well-controlled blood pressure.Thrombocytopenia and hemolytic anemia resolved remarkably.The renal function improved or recovered in 14 of 17 patients,and 3 developed end-stage renal disease on maintenance dialysis.Conclusions Severe intrarenal vascular lesion complicated with renal nephritis parallels clinical manifestation of malignant hypertension.Renal pathology is the key of treatment strategy emphasizing on the significance of renal vascular involvement and type.On the basis of immunosuppressive drugs and steroids to control systemic lupus activity,timely initiation of ACEI/ARB could be of benefit to blood pressure control and long term renal survival.展开更多
Dear Sir,I am Dr. Xiao-Qiang Liu, from the Department of Ophthalmology, Shanghai Tenth People’s Hospital,Tongji University School of Medicine, Shanghai, China. I write to report a case of malignant hypertensive retin...Dear Sir,I am Dr. Xiao-Qiang Liu, from the Department of Ophthalmology, Shanghai Tenth People’s Hospital,Tongji University School of Medicine, Shanghai, China. I write to report a case of malignant hypertensive retinopathy demonstrated by spectral domain optical coherence展开更多
Acute thoracic aortic dissection is part of the acute aortic syndrome triad.Caused by an intimal tear in the lumen of the aorta,it leads to the creation and propagation of a false lumen.In the acute setting this can l...Acute thoracic aortic dissection is part of the acute aortic syndrome triad.Caused by an intimal tear in the lumen of the aorta,it leads to the creation and propagation of a false lumen.In the acute setting this can lead to malignant hypertension,pain and end organ malperfusion.In the chronic setting it can lead to aneurysm formation and rupture.It remains the most common aortic emergency,affecting up to 4 per 100000 people per year in the United Kingdom and United States.Despite advances in treatment and centralisation of vascular services,it continues to be associated with a high pre-admission and in-hospital mortality.Dissection is classified in several ways according to anatomical extent,timing and underlying pathology,all of which guides clinical management.Traditionally,medical management has been the mainstay of treatment in patients with uncomplicated disease.Surgery has been used in symptomatic patients.With published information now available from several prospective international registries,we are beginning to see the advantages of newer surgical treatment options such as endovascular repair,in the acute setting.This review provides an update on diagnosis and management of aortic dissection,including new information that has become available in recent years.展开更多
Membranous nephropathy （MN） is the most common cause of nephrotic syndrome in adults. Its insidious onset and progression often hinder timely renal biopsy and early diagnosis delaying treatment while worsening progn...Membranous nephropathy （MN） is the most common cause of nephrotic syndrome in adults. Its insidious onset and progression often hinder timely renal biopsy and early diagnosis delaying treatment while worsening prognosis. The complication of malignant hypertension （MHT） is rarely seen in idiopathic MN. To provide a better understanding of the disease we report a case of idiopathic MN diagnosed by biopsy six years after onset.展开更多
文摘Objective To investigate the clinical and pathological characteristics of lupus nephritis patients complicated with malignant hypertension.Methods We retrospectively studied 19 patients with lupus nephritis complicated with malignant hypertension who underwent renal biopsy between January 2002 and December 2006.Results Of 19 patients,3 were men and 16 were women,with a mean age of 24.4±7.7 years old.All had positive antinuclear antibodies and low serum complement was found in 13 patients.All were anemic and 12 of them were thrombocytopenic.Impaired renal function was found in 17 patients with an average serum creatinine of 184.5±88.9 μmol/L.Severe intrarenal arteriolar lesion was found in all patients.Six patients had lupus vasculopathy,11 patients had renal thrombotic microangiopathy lesion,2 had severe arteriosclerosis.All patients received steroids and immunosuppressive drugs,15 received angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)with resultant well-controlled blood pressure.Thrombocytopenia and hemolytic anemia resolved remarkably.The renal function improved or recovered in 14 of 17 patients,and 3 developed end-stage renal disease on maintenance dialysis.Conclusions Severe intrarenal vascular lesion complicated with renal nephritis parallels clinical manifestation of malignant hypertension.Renal pathology is the key of treatment strategy emphasizing on the significance of renal vascular involvement and type.On the basis of immunosuppressive drugs and steroids to control systemic lupus activity,timely initiation of ACEI/ARB could be of benefit to blood pressure control and long term renal survival.
文摘Dear Sir,I am Dr. Xiao-Qiang Liu, from the Department of Ophthalmology, Shanghai Tenth People’s Hospital,Tongji University School of Medicine, Shanghai, China. I write to report a case of malignant hypertensive retinopathy demonstrated by spectral domain optical coherence
文摘Acute thoracic aortic dissection is part of the acute aortic syndrome triad.Caused by an intimal tear in the lumen of the aorta,it leads to the creation and propagation of a false lumen.In the acute setting this can lead to malignant hypertension,pain and end organ malperfusion.In the chronic setting it can lead to aneurysm formation and rupture.It remains the most common aortic emergency,affecting up to 4 per 100000 people per year in the United Kingdom and United States.Despite advances in treatment and centralisation of vascular services,it continues to be associated with a high pre-admission and in-hospital mortality.Dissection is classified in several ways according to anatomical extent,timing and underlying pathology,all of which guides clinical management.Traditionally,medical management has been the mainstay of treatment in patients with uncomplicated disease.Surgery has been used in symptomatic patients.With published information now available from several prospective international registries,we are beginning to see the advantages of newer surgical treatment options such as endovascular repair,in the acute setting.This review provides an update on diagnosis and management of aortic dissection,including new information that has become available in recent years.
文摘Membranous nephropathy （MN） is the most common cause of nephrotic syndrome in adults. Its insidious onset and progression often hinder timely renal biopsy and early diagnosis delaying treatment while worsening prognosis. The complication of malignant hypertension （MHT） is rarely seen in idiopathic MN. To provide a better understanding of the disease we report a case of idiopathic MN diagnosed by biopsy six years after onset.
