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Naika. Internal Medicine Jun 1971
Topics: Diuretics; Hexamethonium Compounds; Humans; Hydrazines; Hypertension, Malignant; Male; Methyldopa; Middle Aged; Reserpine; Triamterene
PubMed: 5092025
DOI: No ID Found -
Retina (Philadelphia, Pa.) May 2019
Topics: Adult; Blood Pressure; Choroid; Choroid Diseases; Fluorescein Angiography; Fundus Oculi; Humans; Hypertension, Malignant; Male; Retina; Tomography, Optical Coherence
PubMed: 30893276
DOI: 10.1097/IAE.0000000000002509 -
Seminars in Arthritis and Rheumatism Jun 2015To discuss the pathophysiology, risk factors, clinical manifestations, diagnosis, treatment, prevention, and outcomes of scleroderma renal crisis (SRC), a serious yet... (Review)
Review
OBJECTIVES
To discuss the pathophysiology, risk factors, clinical manifestations, diagnosis, treatment, prevention, and outcomes of scleroderma renal crisis (SRC), a serious yet potentially treatable complication of scleroderma (systemic sclerosis).
METHODS
A PubMed search for articles published up until April 2014 was conducted using the following keywords: scleroderma, systemic sclerosis, scleroderma renal crisis, renal, treatment, and prognosis. Literature was carefully reviewed, and different risk factors, treatment options, prognostic factors, and survival data were assessed.
RESULTS
SRC occurs in about 10% of all patients with scleroderma. It is characterized by malignant hypertension and progressive renal failure. Around 10% of SRC cases may present with normal blood pressure, termed normotensive renal crisis. The etiopathogenesis is presumed to be a series of insults to the kidneys resulting in endothelial injury, intimal proliferation, and narrowing of renal arterioles leading to decreased blood flow, hyperplasia of the juxtaglomerular apparatus, hyperreninemia, and accelerated hypertension. Risk factors include rapid skin thickening, use of certain medications such corticosteroids or cyclosporine, new-onset microangiopathic hemolytic anemia and/or thrombocytopenia, cardiac complications (pericardial effusion, congestive heart failure, and/or arrhythmias), large joint contractures, and presence of anti-RNA polymerase III antibody. Since the 1970s, with the advent of angiotensin-converting enzyme (ACE) inhibitors, mortality associated with SRC decreased from 76% to <10%. Some patients may progress to end-stage renal disease and need dialysis. Renal transplantation has improved survival, though SRC may recur in transplanted kidneys.
CONCLUSIONS
More than 60 years after its initial description, SRC still remains an important cause of morbidity and mortality in scleroderma. Since the advent of ACE inhibitors, the prognosis of SRC has improved substantially. Prompt diagnosis and treatment may help prevent adverse outcomes and improve survival.
Topics: Angiotensin-Converting Enzyme Inhibitors; Disease Progression; Humans; Hypertension, Malignant; Prognosis; Renal Dialysis; Renal Insufficiency; Risk Factors; Scleroderma, Systemic
PubMed: 25613774
DOI: 10.1016/j.semarthrit.2014.12.001 -
Internal Medicine Journal Sep 2010
Topics: Adult; Glomerulonephritis, IGA; Humans; Hypertension, Malignant; Male; Ultrasonography
PubMed: 20840215
DOI: 10.1111/j.1445-5994.2010.02270.x -
Deutsche Medizinische Wochenschrift... Nov 1976
Review
Topics: Adult; Anemia, Hemolytic; Antihypertensive Agents; Blood Volume; Female; Humans; Hypertension, Malignant; Kidney Failure, Chronic; Plasma Substitutes; Renin; Sodium
PubMed: 791604
DOI: 10.1055/s-0028-1104319 -
QJM : Monthly Journal of the... Sep 1995To investigate age-related differences in malignant hypertension (MHT), we studied 38 elderly patients (18 males, 20 females; mean age 70.6 years, SD 4.6 years, range 65...
To investigate age-related differences in malignant hypertension (MHT), we studied 38 elderly patients (18 males, 20 females; mean age 70.6 years, SD 4.6 years, range 65 to 84) and 277 younger patients (193 males, 84 females; mean age 46.4 years, SD 10.5, range 15 to 64) with MHT presenting 1965-93. Mean duration of known hypertension before presentation was greater in the elderly group (43.8 months vs. 23.1 months). The elderly group included 18 (47.4%) newly diagnosed hypertensives, compared to 160 (55.8%) in the younger group. At presentation, 19 (50.0%) elderly patients were receiving no antihypertensive drug therapy, whilst 18 (47.4%) were taking one or more drugs for hypertension. Presenting clinical features in elderly MHT patients included visual disturbance (9), headaches (2), headaches with visual disturbance (2), stroke (3), and heart failure (2). Six patients were asymptomatic. The commonest clinical complications were ischaemic heart disease (angina and myocardial infarction) (5), heart failure (4) and stroke (4). The majority (58%) of patients, however, had no vascular complications at presentation. Comparing elderly and younger MHT groups, there was no significant difference in presenting systolic blood pressures, although mean diastolic blood pressure was significantly greater in the younger group (mean 143.7 mmHg +/- 19.3 vs. 130.0 mmHg +/- 15.2; p < 0.0001). After a mean follow-up of 30.9 months (SD 37.1; range 1 to 123 months), 17 (44.7%) of the elderly patients were still alive, 15 were dead (39.5%) and six were lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Age Factors; Aged; Aged, 80 and over; Cause of Death; England; Female; Follow-Up Studies; Hematuria; Humans; Hypertension, Malignant; Kidney; Male; Proteinuria; Risk Factors; Time Factors
PubMed: 7583078
DOI: No ID Found -
Journal of Postgraduate Medicine Apr 1987
Topics: Adolescent; Adult; Child; Female; Glomerulonephritis; Humans; Hypertension, Malignant; Kidney; Male; Microcirculation; Middle Aged
PubMed: 3681746
DOI: No ID Found -
British Medical Journal (Clinical... Jan 1986The clinical features and survival rates of 200 consecutive patients with malignant and accelerated hypertension admitted to a district hospital were investigated....
The clinical features and survival rates of 200 consecutive patients with malignant and accelerated hypertension admitted to a district hospital were investigated. Ninety five patients had bilateral haemorrhages and exudates and papilloedema (grade IV retinopathy) and 31 had bilateral haemorrhages and exudates with no papilloedema (grade III). A further 74 patients had bilateral retinopathy but failed to meet the criteria for grade IV or III and were investigated separately. No overall differences were found in survival when comparing the various grades of retinopathy. Cigarette smoking was significantly commoner only in grade IV patients compared with those with non-malignant hypertension matched for age, sex, and race. In patients with grade III retinopathy excess smoking was not statistically significant. In conclusion, the clinical features and survival rate showed that malignant and accelerated hypertension are one and the same disease.
Topics: Female; Humans; Hypertension, Malignant; Male; Middle Aged; Papilledema; Retinal Hemorrhage; Retrospective Studies; Smoking
PubMed: 3081084
DOI: 10.1136/bmj.292.6515.235 -
Acta Medica Scandinavica 1979A follow-up was made of 69 patients diagnosed as having malignant hypertension during 1969--76, essential in 26, secondary in 39 and unclassified in 4. A clear male...
A follow-up was made of 69 patients diagnosed as having malignant hypertension during 1969--76, essential in 26, secondary in 39 and unclassified in 4. A clear male dominance was seen (41 men, 28 women), particularly in the group with essential hypertension (18 men, 8 women). The mortality in this series was less than in previously published series. Thus, the 5-year survival rate was 75% in the patients with essential and 72% in those with secondary hypertension. In part this was due to haemodialysis and renal transplantation. The importance of renal function at the time of diagnosis was evident in this study. In most patients with essential hypertension and serum creatinine levels below 300 mumol/l, renal function could be maintained or improved when antihypertensive treatment was instituted, whereas progression of the renal damage was seen in those with serum creatinine levels above 300 mumol/l in spite of antihypertensive treatment with 3 or more drugs. The incidence of new cases of malignant hypertension tended to decrease during the observation period, particularly as regards essential hypertension.
Topics: Adolescent; Adult; Aged; Female; Follow-Up Studies; Humans; Hypertension, Malignant; Kidney Function Tests; Male; Middle Aged; Prognosis; Sweden
PubMed: 532711
DOI: 10.1111/j.0954-6820.1979.tb13553.x -
Przeglad Lekarski 1994Malignant hypertension is the most severe form of hypertension. Untreated--quickly leads to target organs damage and death. The most important things are early diagnosis... (Review)
Review
Malignant hypertension is the most severe form of hypertension. Untreated--quickly leads to target organs damage and death. The most important things are early diagnosis and treatment, which can improve prognosis in the group of patients with malignant hypertension. Pathogenesis of malignant hypertension is not completely established, although histopathological changes are well known. The article presents recent opinions on etiopathogenesis, clinical course and treatment of malignant hypertension.
Topics: Emergencies; Humans; Hypertension, Malignant; Prognosis
PubMed: 8208993
DOI: No ID Found