Hida K, Wada J, Odawara M, Kunitomi M, Hayakawa N, Kashihara N, Makino H
Department of Medicine III, Okayama University Medical School, Okayama, Japan.
Am J Nephrol. 2000 Jan-Feb;20(1):64-7. doi: 10.1159/000013558.
A 34-year-old Japanese male was admitted to Okayama University Hospital with severe hypertension, rapidly progressive renal failure, blurred vision, dyspnea and hemoptysis. Clinical diagnosis of malignant hypertension was given and antihypertensive therapy and hemodialysis were immediately started. Renal biopsy was performed on the sixth day in hospital to examine the underlying disease, such as microscopic form of polyarteritis, since the complaint of hemoptysis and pulmonary alveolar hemorrhage was noted by computed tomography of the lungs. Typical pathological changes of malignant hypertension, i.e. fibrinoid necrosis of the afferent arterioles and proliferative endoarteritis at the interlobular arteries were observed. There was no evidence of active necrotizing glomerulonephritis and crescent formation. Renal function was gradually recovered and pulmonary hemorrhage completely disappeared by treatment with antihypertensive agents. The authors report a case of malignant hypertension with a rare complication of pulmonary alveolar hemorrhage and speculate that it may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.
一名34岁的日本男性因严重高血压、快速进展性肾衰竭、视力模糊、呼吸困难和咯血入住冈山大学医院。临床诊断为恶性高血压，立即开始进行抗高血压治疗和血液透析。由于肺部计算机断层扫描发现咯血和肺泡出血，于住院第六天进行肾活检，以检查潜在疾病，如显微镜下的多发性动脉炎。观察到恶性高血压的典型病理变化，即入球小动脉的纤维蛋白样坏死和小叶间动脉的增生性动脉内膜炎。没有活动性坏死性肾小球肾炎和新月体形成的证据。通过抗高血压药物治疗，肾功能逐渐恢复，肺出血完全消失。作者报告了一例伴有罕见肺泡出血并发症的恶性高血压病例，并推测这可能与恶性高血压引起的肺泡毛细血管水平的血管损伤有关。
