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Chronic thrombotic microangiopathy secondary to antiphospholipid syndrome, presenting with severe hypertension and chronic renal impairment.
BMJ Case Rep 2019; 12(9)BC

Abstract

A 42-year-old woman was referred from a primary care centre for severe hypertension, stage 3A chronic kidney disease and proteinuria. This was associated with a significant obstetric history of pre-eclampsia during her previous two pregnancies. Secondary hypertension was suspected and autoimmune workup was positive for anticardiolipin IgG and lupus anticoagulant. A renal biopsy showed evidence of chronic thrombotic microangiopathy, with electron microscopy features suggestive of fibrillar glomerulonephritis. The diagnosis of antiphospholipid syndrome with antiphospholipid-associated nephropathy was made. She was started on anticoagulation with warfarin, and her hypertension was controlled with lisinopril and amlodipine with subsequent improvement in proteinuria. She remains on regular follow-up to monitor for possible development of malignancy or connective tissue disease.

Authors+Show Affiliations

Department of Internal Medicine, Singapore General Hospital, Singapore.Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.Division of Pathology, Singapore General Hospital, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31527221

Citation

Yee, Yucai, et al. "Chronic Thrombotic Microangiopathy Secondary to Antiphospholipid Syndrome, Presenting With Severe Hypertension and Chronic Renal Impairment." BMJ Case Reports, vol. 12, no. 9, 2019.
Yee Y, Angkodjojo S, Tan PH. Chronic thrombotic microangiopathy secondary to antiphospholipid syndrome, presenting with severe hypertension and chronic renal impairment. BMJ Case Rep. 2019;12(9).
Yee, Y., Angkodjojo, S., & Tan, P. H. (2019). Chronic thrombotic microangiopathy secondary to antiphospholipid syndrome, presenting with severe hypertension and chronic renal impairment. BMJ Case Reports, 12(9), doi:10.1136/bcr-2019-231434.
Yee Y, Angkodjojo S, Tan PH. Chronic Thrombotic Microangiopathy Secondary to Antiphospholipid Syndrome, Presenting With Severe Hypertension and Chronic Renal Impairment. BMJ Case Rep. 2019 Sep 16;12(9) PubMed PMID: 31527221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic thrombotic microangiopathy secondary to antiphospholipid syndrome, presenting with severe hypertension and chronic renal impairment. AU - Yee,Yucai, AU - Angkodjojo,Stanley, AU - Tan,Puay Hoon, Y1 - 2019/09/16/ PY - 2019/9/19/entrez KW - chronic renal failure KW - connective tissue disease KW - general practice / family medicine JF - BMJ case reports JO - BMJ Case Rep VL - 12 IS - 9 N2 - A 42-year-old woman was referred from a primary care centre for severe hypertension, stage 3A chronic kidney disease and proteinuria. This was associated with a significant obstetric history of pre-eclampsia during her previous two pregnancies. Secondary hypertension was suspected and autoimmune workup was positive for anticardiolipin IgG and lupus anticoagulant. A renal biopsy showed evidence of chronic thrombotic microangiopathy, with electron microscopy features suggestive of fibrillar glomerulonephritis. The diagnosis of antiphospholipid syndrome with antiphospholipid-associated nephropathy was made. She was started on anticoagulation with warfarin, and her hypertension was controlled with lisinopril and amlodipine with subsequent improvement in proteinuria. She remains on regular follow-up to monitor for possible development of malignancy or connective tissue disease. SN - 1757-790X UR - https://www.unboundmedicine.com/medline/citation/31527221/Chronic_thrombotic_microangiopathy_secondary_to_antiphospholipid_syndrome,_presenting_with_severe_hypertension_and_chronic_renal_impairment L2 - https://casereports.bmj.com/cgi/pmidlookup?view=long&pmid=31527221 DB - PRIME DP - Unbound Medicine ER -