lisinopril and Thrombotic-Microangiopathies

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.

Topics: Adult; Amlodipine; Anticoagulants; Antihypertensive Agents; Antiphospholipid Syndrome; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Hypertension; Kidney Diseases; Lisinopril; Thrombotic Microangiopathies; Warfarin

A 67-year old patient underwent a kidney biopsy because of newly diagnosed hypertension, haemolytic anemia with fragmentocytes and acute kidney failure requiring dialysis therapy. The biopsy showed thrombotic microangiopathy. Since last winter Raynaud's phenomenon and changes of hands and lips were recognised.. Initial immunological tests revealed anti-nuclear antibodies (ANA) but neither anti-centromere nor anti-Scl70 antibodies. The positive analysis of anti-RNA polymerase III antibodies confirmed the clinical suspicion of scleroderma renal crisis in the setting of first diagnosis of systemic sclerosis.. After diagnosis therapy with lisinopril, candesartan and amlodipin was established. Four months after discharge dialysis dependency persisted.. Scleroderma renal crisis is an important differential diagnosis in the setting of acute kidney failure. Medical history, clinical examination and immunological test confirm the diagnosis. The mainstay of therapy is aggressive blood pressure control with ACE-inhibitors (or angiotensin receptor blocking agents).

Topics: Aged; Amlodipine; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Antibodies, Antinuclear; Benzimidazoles; Biopsy; Biphenyl Compounds; Combined Modality Therapy; Diagnosis, Differential; Humans; Kidney; Kidney Failure, Chronic; Kidney Glomerulus; Lisinopril; Male; Plasmapheresis; Renal Dialysis; RNA Polymerase II; Scleroderma, Systemic; Tetrazoles; Thrombotic Microangiopathies; Vasodilator Agents