Aithal S, Marley N, Venkat-Raman G
Morriston Hospital, Swansea, UK.
Clin Nephrol. 2009 Oct;72(4):322-5. doi: 10.5414/cnp72322.
A 38-year-old Caucasian male presented with a 4-week history of nose bleeds, gross hematuria and blurred vision. He was a smoker, who had used cannabis and cocaine previously. At presentation, he had features of malignant hypertension (blood pressure 220/120 mmHg), was hypoxic on room air, with no signs of fluid overload or heart failure. He had acute renal failure with radiological evidence of alveolar hemorrhage. Renal biopsy showed extensive ischemic collapse of glomeruli and severe fibrointimal thickening of the arteries with fibrinoid deposits in the wall. Auto-immune screen was negative. Serum creatinine peaked at 749 micromol/l. Adequate control of blood pressure and supportive oxygen therapy lead to a complete clinical and radiological resolution of the pulmonary hemorrhage and he did not need dialysis. Eighteen months on, his serum creatinine is stable at 279 micromol/l with good blood pressure control. Malignant hypertension is not a recognized cause of the renal-pulmonary syndrome and physicians should be aware of the possibility, if only to avoid inappropriate treatments like plasmapheresis and immunosuppression. History of cocaine use is important in the setting of an acute vascular event.
一名38岁的白种男性出现鼻出血、肉眼血尿和视力模糊4周。他是一名吸烟者，既往使用过大麻和可卡因。就诊时，他有恶性高血压的表现（血压220/120 mmHg），在室内空气中存在低氧血症，无液体超负荷或心力衰竭的体征。他患有急性肾衰竭，并有肺泡出血的影像学证据。肾活检显示肾小球广泛缺血性塌陷，动脉严重纤维内膜增厚，壁内有纤维蛋白样沉积。自身免疫筛查为阴性。血清肌酐峰值为749微摩尔/升。血压的充分控制和支持性氧疗使肺出血在临床和影像学上完全消退，他无需透析。18个月后，他的血清肌酐稳定在279微摩尔/升，血压控制良好。恶性高血压并非公认的肾肺综合征病因，医生应意识到这种可能性，哪怕只是为了避免不适当的治疗，如血浆置换和免疫抑制。在急性血管事件的背景下，可卡因使用史很重要。
