Hypertension maligne à l'hôpital Fousseyni Daou de Kayes, au Mali: aspects épidémio-cliniques et pronostiques / Malignant hypertension at the Fousseyni Daou hospital in Kayes, Mali: epidemiological and prognostic aspects

L'hypertension artérielle maligne (HTAM) est un problème de santé publique en Afrique subsaharienne. L'objectif de cette étude était de décrire le profil épidémio-clinique et les facteurs pronostiques de l'HTAM à Fousseyni DAOU de Kayes. Méthodes. Nous avons réalisé une étude rétrospective et descriptive du 1er janvier 2016 au 31 juin 2022 à l'unité de néphrologie de l'hôpital Fousseyni Daou de Kayes. Étaient inclus, les patients hypertendus ou normotendus sous traitement hospitalisés avec une rétinopathie hypertensive (RH) de stade II ou III (selon la classification de Kirkendall) associée à une ou plusieurs autres atteintes viscérales et ayant un dossier médical complet. Résultats. Au total 117 cas d'HTAM ont été enregistrés sur 7011 dossiers examinés, dont 53,8% d'hommes (63 cas). L'âge moyen était de 39,47 ans. La moyenne de la pression artérielle à l'admission était de 187/114 mmHg. La RH était de stade II et III dans 59,8% et 40,2% des cas. L'insuffisance rénale était retrouvée chez 93,1% des patients (109 cas) dont 63,7% d'insuffisance rénale chronique (IRC) contre 36,7% d'insuffisance rénale aiguë (IRA). L'hypertrophie ventriculaire gauche a été retrouvée dans 80,4% des cas. L'issue globale des patients a été favorable dans 59% (69 cas) contre 31,6% (37 cas) de décès et 9,4% (11 cas) de sortie contre avis médical. Les facteurs associés au risque de décès étaient surtout la RH stade III, la dyslipidémie, l'IRC terminale et l'hyponatrémie. Conclusion. L'HTAM reste un problème de santé publique au Mali et touche préférentiellement les sujets jeunes avec une morbi mortalité élevée

Treatment Outcomes in COVID-19 patients with comorbidities in Kaduna state, NorthwesternNigeria

Background: Severe COVID-19 disease has been reported among people with underlying conditions such as diabetes, chronic respiratory diseases, cancer, obesity, and cardiovascular disease. This study determined the outcomes of COVID-19 among patients with comorbidities in Kaduna state, where we have the highest incidence in northern Nigeria.Methods: This study was a retrospective, descriptive cross-sectional review of the clinical records involving all age groups of 902 COVID-19 patients admitted at the four isolation centers of the Kaduna State Infectious Disease Control Centre (IDCC) between March 27th2020 to December 31st2021. Data was analyzed with SPSS version 25 and STATA SE 12 with p <0.05.Results: Out of the 902 cases, 245(27.2%) had comorbidities, hypertension 206(22.8%) was the most recorded comorbidity, others were diabetes 77(8.5%), asthma 7 (0.78%), HIV 7(0.78%), sickle cell anemia 7 (0.78%) and PTB 3 (0.33%). Patients with comorbidities had prolonged mean duration of symptoms 8.36±3.5 days, compared to 7.2±2.7 days in those without comorbidities (p=0.001).Multivariate logistic regression analysis further shows that the odds for clinical recovery from the COVID-19 disease was significantly lower for patient with hypertension (AOR=0.13, 95%CI=0.06-0.27, p = <0.01), diabetic (AOR=0.20, 95% CI=0.10-0.40, p<0.01) and HIV comorbidities (AOR=0.1, 95%CI=0.01-0.98, p=0.05) compared to those without comorbiditiesConclusion: Hypertension and diabetes were the major comorbidities in this study. Most patients with comorbidities had severe presentations and fatal poorer outcome. There is a need for sustained public health education targeted at patients with chronic diseases to be screened and treated early for COVID 19 Disease

Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus

Objective: To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians. Design: We undertook a secondary analysis of data collected in a prospective study Setting: The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana Main outcome measures: We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation. Results: The mean SD of individual patient visit-to-visit SBP overall was 14.8±6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted ß coefficients (95% CI) included age: 0.06 (0.03 ­ 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 ­ 4.68) and Methyldopa 3.08 (2.39 ­ 3.77). Conclusion: Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.

Intensive care unit deaths among neurosurgery patients in a tertiary hospital in South Western Nigeria

Neurosurgical patients are the most critical ICU admissions. While advancements in neurosurgical ICUs (NICU) have improved outcomes of care globally, ICU mortality remains a major clinical issue in developing nations. This study evaluates ICU mortalities of neurosurgical patients in a general ICU setting at the UNIOSUN Teaching Hospital, Osogbo, Nigeria. Method: Case records of neurosurgery patients who died in the ICU of UNIOSUN Teaching Hospital, Osogbo, South-Western, Nigeria from June 2012 to May 2022 were reviewed. Simple descriptive statistics of data on demographics, clinical diagnoses, management and outcome were done. Results: Mortality rate was 38.9% (84 of 216 admissions). Males were 67(79.8%) and the mean age was 41.5years (Range: 2-85years). The average duration of ICU stay was 3.5days (Range: 30minutes-20days). Most patients had severe traumatic brain injury (TBI) (62, 73.8%). This was followed by cerebrovascular diseases (12, 14.3%) and brain tumours (6, 7.1%). Two had brain abscess. One patient each had mixed subacute/chronic subdural haematoma and severe cervical spondylotic myelopathy. Of the 69 whose case files were found, 7(10.1%) had a diagnosis of brainstem death before eventual 'final' death after an average of 13.5 additional hours on mechanical life support. The identified secondary causes of death included raised ICP, sepsis, primary surgical haemorrhage, seizures, acute kidney injury, malignant hypertension, poor glycaemic control and aggressive blood pressure lowering. Only 1 patient had autopsy. Conclusion: Most ICU mortalities among neurosurgical patients were from severe TBI. The establishment of NICU is necessary to improve outcome of care of neurosurgical patients

Retinopatia hipertensiva maligna secundária a lúpus eritematoso sistêmico em adolescente / Malignant hypertensive retinopathy secondary to systemic lupus erythematous in adolescent

RESUMO O lúpus eritematoso sistêmico é uma doença que pode apresentar comprometimento oftalmológico geralmente benigno, sendo as alterações mais encontradas a síndrome do olho seco e a catarata. Nos pacientes com a doença estável, o dano oftalmológico parece estar relacionado ao tratamento sistêmico a longo prazo, o que enfatiza a importância do exame oftalmológico completo de rotina. Porém, quando a doença está em franca atividade e, em especial, quando há o envolvimento renal, deve-se iniciar o tratamento precoce com corticoterapia sistêmica e com medidas de suporte, para se evitarem repercussões mais complexas, como as crises hipertensivas que podem levar ao óbito.

ABSTRACT Systemic lupus erythematosus may present ophthalmological involvement, usually benign, and the most common changes are dry eye syndrome and cataract. In patients with stable disease, ophthalmologic damage appears to be related to long-term systemic treatment, emphasizing the importance of routine complete ophthalmologic examination. However, in full-blown disease, especially when there is renal involvement, early treatment should start with systemic steroid therapy and supportive measures, to avoid major repercussions, such as hypertensive crises that may lead to death.

A importância do diagnóstico precoce da hipertensão maligna: Relato de caso / The importance of early diagnosis of malignant hypertension - Case report

A hipertensão maligna é uma síndrome constituída por hipertensão arterial grave, retinopatia com papiledema (com ou sem insuficiência renal) e necrose fibrinóide de arteríolas renais, a qual pode apresentar evolução clínica rapidamente progressiva e fatal.Nela ocorrem lesões vasculares que consistem predominantemente de proliferação miointimal e necrose fibrinóide arteriolar, as quais podem se desenvolver agudamente e comprometer o lúmen dos pequenos vasos. O prognóstico da hipertensão maligna é quase sempre fatal se não for reconhecida ou não for tratada adequadamente, apresentando uma mortalidade de cerca de 80% em dois anos, principalmente em decorrência da evolução para síndrome de insuficiência cardíaca e insuficiência renal terminal. (AU).

Malignant hypertension is a syndrome consisting of severe arterial hypertension, retinopathy with papilledema (with or without renal failure) and fibrinoid necrosis of renal arterioles, which may present a rapidly progressive and fatal clinical course. In this pathology may occur vascular lesions that consist mainly of myointimal proliferation and arteriolar fibrinoid necrosis, which can develop acutely and compromise the light from the small blood vessels. The prognosis of malignant hypertension is almost always fatal if it is not recognized or not adequately treated, with a mortality rate of about 80% in 2 years, mainly as a result of progression into heart failure syndrome and end-stage renal failure syndrome (AU).

Optical coherence tomography angiography findings in malignant hypertensive retinopathy / Achados da angiografia por tomografia de coerência óptica na retinopatia hipertensiva maligna

ABSTRACT A 33-year-old male presented to our clinic with low vision in both eyes that started during the previous week. Visual acuity was 20/63 in the right eye and 20/50 in the left eye. Fundus examination revealed signs of hypertensive retinopathy; thus, a multidisciplinary approach was adopted for the diagnosis and treatment of this patient. We consulted the nephrology and cardiology departments on this case. Upon diagnosing malignant hypertension and renal failure, the patient was put on hemodialysis. His visual acuity was 20/20 at 6 months, whereas foveal assessment on optical coherence tomography angiography revealed neither marked superficial and deep capillary density loss and foveal avascular zone enlargement nor a decrease in disc flow and radial peripapillary capillary density. Early diagnosis and treatment of malignant hypertension are critical in preventing progression of end-organ damage including the eyes. Optical coherence tomography angiography may be useful in cases when fundus fluorescein angiography is relatively contraindicated (e.g., renal failure).

RESUMO Um homem de 33 anos apresentou-se à nossa clínica com baixa visão em ambos os olhos que começou uma semana antes. A acuidade visual foi de 20/63 no olho direito e 20/50 no olho esquerdo. O exame de fundo de olho revelou sinais de retinopatia hipertensiva; então, adotou-se uma abordagem multidisciplinar para o diagnóstico e tratamento desse paciente. Consultamos os departamentos de nefrologia e cardiologia neste caso. Ao diagnosticar hipertensão maligna e insuficiência renal, o paciente foi colocado em hemodiálise. Sua acuidade visual era 20/20 aos 6 meses, enquanto a avaliação foveal com angiotomografia de coerência óptica não revelou perda de densidade capilar superficial e profunda acentuada e aumento da zona avascular foveal nem uma diminuição no fluxo de disco e na densidade capilar peripapilar radial. O diagnóstico precoce e o tratamento da hipertensão maligna são fundamentais na preveção da progressão de danos nos órgãos-alvo, incluindo os olhos. A Angiografia por tomografia de coerência óptica pode ser útil nos casos em que a angiografia com fluoresceína do fundo de olho é relativamente contraindicada (por exemplo, insuficiência renal).

Differential Diagnosis and Treatment of Thrombotic Microangiopathy Syndrome / 대한내과학회지

Diagnosis of thrombotic microangiopathy (TMA) is challenging due to its close association with other forms of microangiopathic hemolytic anemia, such as malignant hypertension and disseminated intravascular coagulation, and because other manifestations including cytopenia and acute kidney injury are manifestations of other medical comorbidities. Further challenges for accurate diagnosis include distinguishing between primary and secondary TMA, as well as between hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). TTP is typically differentiated from HUS by the presence of more severe thrombocytopenia, along with a higher frequency of altered mental status with relatively preserved renal function. However, the clinical course can vary among patients, requiring polymerase chain reaction testing of patient stools for enterohemorrhagic Escherichia coli and a disintegrin and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS13) assay. To reduce the mortality rate, prompt initiation of plasmapheresis is important in cases where TPP cannot be excluded. Future advances enabling more rapid testing for ADAMTS13 levels will reduce the need for unnecessary plasmapheresis, so that treatment strategy can be more optimized.

Malignant Hypertension with Pulmonary Alveolar Hemorrhage Needing Dialysis / 이화의대지

A 35-year-old man presented with progressive dyspnea and hemoptysis. His blood pressure was 230/140 mmHg and serum creatinine level was 20.13 mg/dL. Chest radiography and computed tomography revealed pulmonary hemorrhage. His renal function was low, thus emergent renal replacement therapy was required. Malignant hypertension and acute kidney injury were diagnosed, and antihypertensive therapy and hemodialysis started immediately. Renal biopsy was performed to examine the underlying disease. Typical pathological changes of malignant hypertension, fibrinoid necrosis of the afferent arterioles, and proliferative endoarteritis at the interlobular arteries were observed. His renal function improved gradually and pulmonary hemorrhage completely disappeared with administration of antihypertensive agents. Here, we report this rare case of malignant hypertension with pulmonary alveolar hemorrhage and speculate that the hemorrhage may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.

Perioperative anesthetic management of a patient with catecholamine-secreting paraganglioma: A case report

Paraganglioma is an uncommon neuroendocrine tumor of cells that originate in the autonomic nervous system. Some paragangliomas have the ability to secrete catecholamines, similar to secretions in pheochromocytoma. For this reason, paragangliomas may cause malignant hypertension in patient, upon being administered anesthesia, or during surgery, this may lead to a life-threatening condition, despite the tumor having been diagnosed before conducting the procedure. Therefore, it is important to take adequate actions for reducing the occurrence of morbidity and mortality during surgery. Here, we describe a successful anesthetic management in a patient diagnosed with retroperitoneal paraganglioma invading the iliac bone.

Idiopathic midaortic syndrome with malignant hypertension in 3-year-old boy / 소아과

Midaortic syndrome (MAS) is a rare vascular disease that commonly causes renovascular hypertension. The lumen of the abdominal aorta narrows and the ostia of the branches show stenosis. MAS is associated with diminished pulses in the lower extremities compared with the upper extremities, severe hypertension with higher blood pressure in the upper rather than lower extremities, and an abdominal bruit. The clinical symptoms are variable, and recognition in children with hypertension can aid early diagnosis and optimal treatment. Hypertension with MAS is malignant and often refractory to several antihypertensive drugs. Recently, radiologic modalities have been developed and have led to numerous interventional procedures. We describe the case of a 3-year-old boy presenting with left ventricular hypertrophy whose severely elevated blood pressure led to the diagnosis of idiopathic MAS. This case highlights the importance of measuring blood pressure and conducting a detailed physical examination to diagnose MAS. This is the first reported case of idiopathic MAS diagnosed in childhood in Korea.

A Case of Noonan Syndrome Presenting with Malignant Hypertension in an Adult / 대한내과학회지

Noonan syndrome is an autosomal dominant disorder characterized by dysmorphic facial features, congenital heart defects and short stature. To date, renal artery stenosis has not been associated with Noonan syndrome. We report the case of a 27-year old male who presented with malignant hypertension associated with renal artery stenosis, dysmorphic facial features, pectus excavatum, pulmonary stenosis and hypertrophic cardiomyopathy who was diagnosed with Noonan syndrome.

A Case of Membranous Glomerulonephritis with Superimposed Anti-Neutrophil Cytoplasmic Antibody-Associated Rapidly Progressive Crescentic Glomerulonephritis / 전남의대학술지

Idiopathic membranous glomerulonephritis (IMGN) is commonly diagnosed in adults with proteinuria. Rapid deterioration of renal function is a rare complication of IMGN, except when accompanied by renal vein thrombosis, malignant hypertension, or other underlying disease, including lupus nephritis. Here, we present a case of rapid deterioration of renal function in a patient with MGN superimposed with anti-neutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive crescentic glomerulonephritis (RPGN). Overall, about 20 cases of MGN with ANCA-associated RPGN have been reported. This case of biopsy-proven MGN with ANCA-associated RPGN is the first to be reported in Korea.

A Case of Membranous Glomerulonephritis with Superimposed Anti-Neutrophil Cytoplasmic Antibody-Associated Rapidly Progressive Crescentic Glomerulonephritis / 전남의대학술지

Idiopathic membranous glomerulonephritis (IMGN) is commonly diagnosed in adults with proteinuria. Rapid deterioration of renal function is a rare complication of IMGN, except when accompanied by renal vein thrombosis, malignant hypertension, or other underlying disease, including lupus nephritis. Here, we present a case of rapid deterioration of renal function in a patient with MGN superimposed with anti-neutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive crescentic glomerulonephritis (RPGN). Overall, about 20 cases of MGN with ANCA-associated RPGN have been reported. This case of biopsy-proven MGN with ANCA-associated RPGN is the first to be reported in Korea.

Hipertensão acelerada-maligna / Malignant hypertension

A hipertensão maligna é uma síndrome constituída por hipertensão arterial grave, retinopatia com papiledema, com ou sem insuficiência renal, necrose fibrinoide de arteríolas renais e que pode apresentar evolução clínica rapidamente progressiva e fatal. Ocorrem lesões vasculares que consistem predominantemente de proliferação miointimal e necrose fibrinóoide arteriolar, as quais podem se desenvolver agudamente e comprometer o lúmen dos pequenos vasos. O prognóstico da hipertensão maligna é quase sempre fatal se esta não for reconhecida ou não tratada adequadamente, com uma mortalidade de cerca de 80% em 2anos, principalmente em decorrência de insuficiência cardíaca e insuficiência renal terminal.

Malignant hypertension is a syndrome composed of severe hypertension, retinopathy with papilledema, with or without renal failure, renal arteriolar fibrinoid necrosis, and can provide rapidly progressive and fatal clinical outcome. Vascular lesions can occur, predominantly consisting of myointimal proliferation and arteriolar fibrinoid necrosis, which can develop sharply and compromise the lumen of the small vessels. The prognosis of malignant hypertension is almost always fatal if unrecognized and not properly treated, with a mortality rate of about 80% in 2 years, mainly due to heart failure and terminal renal failure.

Thrombotic microangiopathy resulting from neglected blood pressure control

Hypertensive nephrosclerosis is usually associated with chronic hypertension, which increases the risk of progressive renal disease. Among the causes of malignant hypertension, thrombotic microangiopathy is complicated and is associated with renal dysfunction at the time of diagnosis. In this case, a young man with hypertension presented with renal failure and thrombocytopenia in the emergency department. This case emphasizes the importance of early recognition of renal failure and thrombocytopenia among patients with uncontrolled hypertension.

Changes in Subfoveal Choroidal Thickness in Malignant Hypertension Patients

PURPOSE: To evaluate changes in subfoveal choroidal thickness in patients with malignant hypertension. METHODS: A total of 12 eyes of six malignant hypertension patients were included in the present study. Intraocular pressure, blood pressure (systolic and diastolic), and choroidal thickness were measured before and after blood pressure control. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). The changes in choroidal extravascular density of the EDI-OCT image after blood pressure control were evaluated by comparing brightness values obtained with Adobe Photoshop software. RESULTS: The subfoveal choroidal thickness (SFCT) of malignant hypertension patients was 412.63 +/- 66.55 microm (mean +/- SD), which was thicker than in normal patients. After blood pressure control, SFCT decreased significantly to 356.96 +/- 59.08 microm (mean +/- SD) (p = 0.002). The choroidal extravascular density of the EDI-OCT image decreased after blood pressure control (p = 0.002), and the mean change was 17.21 +/- 7.56. CONCLUSIONS: The choroid is thickened in patients with malignant hypertension, and its thickness decreases after blood pressure control. This suggests that changes in blood pressure may affect choroidal thickness.

Crise hipertensiva, pseudocrise hipertensiva e elevação sintomática da pressão arterial / Hypertensive crisis, pseudo-hypertensive crisis and symptomatic increase in blood pressure

Fundamentos: Nas elevações agudas da hipertensão arterial sistêmica (HAS), a intervenção imediata e cuidadosa é essencial para a redução da morbidade e da mortalidade decorrentes dessa complicação.Objetivos: Identificar a frequência de urgência hipertensiva (UH), emergência hipertensiva (EH), pseudocrise hipertensiva (PCH) e elevação sintomática da pressão arterial (ESPA). Comparar o conhecimento prévio da HAS, o uso prévio de anti-hipertensivos (AH), os níveis pressóricos apresentados e os desfechos hospitalares nos grupos estudados. Métodos: Estudo analítico, casos e controles, seleção consecutiva e análise retrospectiva de pacientes com elevação aguda da pressão arterial, admitidos na emergência de hospital cardiológico de atendimento privado, entre 11/2009 e 10/2010. Casos representam os pacientes com crise hipertensiva (CH): UH+EH. Controles representam os pacientes sem CH: PCH+ESPA. Resultados: Foram estudados 216 atendimentos relacionados à HAS, 113 (52,0 %) mulheres, idade entre 25-95 anos, mediana de 58 anos. EH foi diagnosticada em 18 (8,0 %) pacientes, UH em 29 (13,0 %), PCH em 8 (4,0 %) e ESPA em 161 (75,0 %). Diagnóstico e tratamento prévio de HAS não diferiram nos grupos com e sem CH. Sintomas cardiovasculares, prescrição de AH e internação foram mais frequentes naqueles com CH (p<0,05); mas apenas 7,0 % dos pacientes não receberam AH. Não houve óbitos.Conclusões: Na população estudada, CH foi identificada em 21,0 % dos casos e o tratamento AH foi aplicado em 93,0 % dos casos. O diagnóstico de HAS e tratamento AH prévio não diferiram naqueles pacientes com e sem CH.

Background: For systemic high blood pressure (SHBP) surges, immediate and careful intervention is essential for reducing morbidity and mortality rates related to this complication.Objectives: To identify the frequency of hypertensive urgency (HU), hypertensive emergency (HE), pseudo-hypertensive crisis (PHC) and symptomatic blood pressure increase (SBPI). Compare prior knowledge of SHBP, previous use of anti-hypertensive (AH), pressure levels presented and hospital outcomes in both groups. Methods: Analytical, case and control study with consecutive selection and retrospective analysis of patients with acute increase in blood pressure, admitted to the emergency cardiac care unit at a private hospital, between November 2009 and October 2010. The cases were patients with hypertensive crisis (HC): HU + HE. The controls were patients without HC: PHC + SBPI. Results: A total of 216 cases related to SHBP were studied, consisting of 113 (52 %) women between 25 and 95 years old, with a median age of 58 years. HE was diagnosed in 18 (8 %) patients, HU in 29 (13 %), PHC in 8 (4 %) and SBPI in 161 (75 %). Prior diagnosis and treatment of SHBP did not differ between the groups with and without HC. Cardiovascular symptoms, hospitalization and AH prescriptions were more frequent among those with HC (p <0.05), but only 7 % of the patients did not receive AH. There were no deaths. Conclusions: In this population studied, HC was identified in 21 % of the cases and AH treatment was administered in 93 % of cases diagnosed with SHBP. Prior AH treatment did not differ among patients with and without HC.

Edema pulmonar tipo flash secundario a trombosis de la arteria renal (síndrome de Pickering) por síndrome antifosfolípido catastrófico / Flash pulmonary edema secondary to renal artery thrombosis (Pickering syndrome) for catastrophic antiphospholipid syndrome

Resumen Se presenta el caso de una mujer de 24 años con diagnóstico de edema pulmonar agudo flash, asociado a estenosis de la arteria renal secundaria, a síndrome antifosfolípido catastrófico, quien recibió manejo con esteroide endovenoso, inmunoglobulina y plasmaféresis, a pesar del tratamiento continuó con deterioro clínico, presentó múltiples episodios de emergencia hipertensiva y edema pulmonar agudo, por lo cual requirió manejo en unidad de cuidados intensivos. Se realizó angiorresonancia de aorta abdominal, arterias renales e iliacas, mostrando obstrucción del 80% de la aorta abdominal, con obstrucción del 70% de arteria renal derecha, finalmente la paciente presentó disfunción multiorgánica y fallece.

Abstract A case of a woman of 24 years with an acute pulmonary edema secondary to catastrophic antiphospholipid syndrome associated with high blood pressure, management is performed with poor response to the request of management persist in intensive care unit, steroid use was started intravenous immunoglobulin and plasmaferis, but the patient continued with clinical deterioration. Origin was suspected reno vascular hypertension was performed Resonance Angiography of the abdominal aorta, renal and iliac showing: 80% obstruction of the abdominal aorta, with 70% obstruction of the right renal artery, iliac side from supplying abdomen, the patient presents multiple organ dysfunction and died.