Higashi Atsuko Y, Nogaki Fumiaki, Ono Takahiko, Fukatsu Atsushi
Department of Nephrology, Kyoto University Hospital, Kyoto, Japan.
Nihon Jinzo Gakkai Shi. 2009;51(7):878-83.
A 19-year-old male was admitted to our hospital for the treatment of severe hypertension with renal dysfunction. Two years before admission, his hypertension had been diagnosed as essential hypertension based on a series of examinations when his renal function was not impaired. Visits to his primary physician ended when he developed severe hypertension of 210/140 mmHg, at which time renal dysfunction and serum creatinine of 2.25 mg/dL were discovered. Renin and antidiuretic hormone were slightly elevated, but renal artery stenosis or other abnormalities were not detected by magnetic resonance imaging and computer tomography. After the hypertension was controlled by medication, a renal biopsy was performed to assess renal impairment. Histology demonstrated lesions compatible with thrombotic microangiopathy (TMA) and ischemic lesions, including fibrinoid necrosis, intimal thickening, occlusion in the small arteries, wrinkling and duplication of the glomerular basement membrane with microthrombi, and focal interstitial fibrosis. Renal function ameliorated after the hypertension was controlled. This case suggests that severe and accelerated hypertension can cause TMA with renal impairment even in young people.
一名19岁男性因严重高血压伴肾功能不全入院治疗。入院前两年，在其肾功能未受损时，经一系列检查，其高血压被诊断为原发性高血压。当他出现210/140 mmHg的严重高血压时，他停止了去看初级医生，此时发现了肾功能不全和血清肌酐为2.25 mg/dL。肾素和抗利尿激素略有升高，但磁共振成像和计算机断层扫描未检测到肾动脉狭窄或其他异常。在通过药物控制高血压后，进行了肾活检以评估肾功能损害。组织学显示与血栓性微血管病（TMA）和缺血性病变相符的病变，包括纤维蛋白样坏死、内膜增厚、小动脉闭塞、肾小球基底膜皱缩和重复伴微血栓形成，以及局灶性间质纤维化。高血压得到控制后，肾功能有所改善。该病例表明，即使在年轻人中，严重且进展迅速的高血压也可导致伴有肾功能损害的TMA。
