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 CASE REPORT
Year : 2017  |  Volume : 27  |  Issue : 2  |  Page : 136-140

Targeting renin-angiotensin system in malignant hypertension in atypical hemolytic uremic syndrome


1 Pediatric Critical Care Unit, Medanta - The Medicity, Gurgaon, Haryana, India
2 Kidney Institute, Medanta - The Medicity, Gurgaon, Haryana, India
3 Department of Immunology, Georges Pompidou European Hospital, APHP, Paris, France
4 Department of Pediatric Nephrology, Akron Children's Hospital, Akron, Ohio, USA

Correspondence Address:
S K Sethi
Consultant, Pediatric Nephrology, Kidney Institute, Medanta - The Medicity, Gurgaon - 122 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.181462

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Hypertension is common in hemolytic uremic syndrome (HUS) and often difficult to control. Local renin-angiotensin activation is believed to be an important part of thrombotic microangiopathy, leading to a vicious cycle of progressive renal injury and intractable hypertension. This has been demonstrated in vitro via enhanced tissue factor expression on glomerular endothelial cells which is enhanced by angiotensin II. We report two pediatric cases of atypical HUS with severe refractory malignant hypertension, in which we targeted the renin-angiotensin system by using intravenous (IV) enalaprilat, oral aliskiren, and oral enalapril with quick and dramatic response of blood pressure. Both drugs, aliskiren and IV enalaprilat, were effective in controlling hypertension refractory to multiple antihypertensive medications. These appear to be promising alternatives in the treatment of severe atypical HUS-induced hypertension and hypertensive emergency.






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Indian Journal of Nephrology
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Online since 20th Sept '07