Letter to the Editor
Thrombotic microangiopathy and accelerated hypertension after treatment with interferon beta
Microangiopatía trombótica e hipertensión acelerada tras tratamiento con interferón beta
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"apellidos" => "Ortega" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0211699518300365" "doi" => "10.1016/j.nefro.2018.02.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518300365?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301147?idApp=UINPBA000064" "url" => "/20132514/0000003800000005/v1_201811140611/S2013251418301147/v1_201811140611/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Thrombotic microangiopathy and accelerated hypertension after treatment with interferon beta" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "564" "paginaFinal" => "565" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elisa Pereira Pérez, María Dolores Sánchez de la Nieta García, Lucía González López, Francisco Rivera Hernández" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Elisa Pereira" "apellidos" => "Pérez" "email" => array:1 [ 0 => "elisapereirap@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Dolores" "apellidos" => "Sánchez de la Nieta García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Lucía González" "apellidos" => "López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Francisco Rivera" "apellidos" => "Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología del Hospital Universitario General de Ciudad Real, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica del Hospital Universitario General de Ciudad Real, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Microangiopatía trombótica e hipertensión acelerada tras tratamiento con interferón beta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 975 "Tamanyo" => 118247 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fibrin thrombi occluding the glomerular capillary lumen. (A and B) Red Masson staining. X63. (C) Eosinophil with HE. X63. (D) Not stained with silver methenamine. X63.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report a case of a 48-year-old patient with multiple sclerosis (MS) since she was 18, receiving treatment with beta-interferon 1-a three times a week for the past 9 years and with no other medical treatment or relevant family history.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient referred symptoms of upper respiratory infection for the last 15 days for which she had been receiving symptomatic treatment. She presented high blood pressure, decreased urine output (with no macroscopic changes), and impaired renal function. Significant findings of the physical examination included blood pressure values of 190/93<span class="elsevierStyleHsp" style=""></span>mmHg and edema of the lower limbs up to the knees. In addition, crossings and cotton wool spots were observed in the ocular fundus.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Blood tests showed hemoglobin levels of 9.8<span class="elsevierStyleHsp" style=""></span>g/dL with an MCV of 93.5<span class="elsevierStyleHsp" style=""></span>fl, platelet values of 142<span class="elsevierStyleHsp" style=""></span>mil/uL, and LDH of 588<span class="elsevierStyleHsp" style=""></span>IU/L, total bilirubin of 1.2<span class="elsevierStyleHsp" style=""></span>mg/dL, creatinine of 1.9<span class="elsevierStyleHsp" style=""></span>mg/dL, and proteinuria of 0.8<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h; in the urine sediment: cell counts were 4–6 RBCs/field, 25–30 leukocytes/field, and common bacteria. A peripheral blood smear was performed, with 2% of schistocytes. The renal Doppler ultrasound and echocardiogram were normal as was the immunological study, HCV, HBV and HIV serology values. Haptoglobin was undectectable, and creatinine was increased to 2.5<span class="elsevierStyleHsp" style=""></span>mg/dL. In the absence of gastrointestinal symptoms, shigatoxin was not tested for. The ADAMTS 13 test was normal and the direct Coombs test was negative. A renal biopsy was performed, which was compatible with thrombotic microangiopathy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Suspecting that beta interferon could have been the cause of thrombotic microangiopathy and/or accelerated hypertension, the drug was discontinued. After five months, the patient presented improved renal function with creatinine levels of 1.6<span class="elsevierStyleHsp" style=""></span>mg/dL and with a urine protein/creatinine ratio of 0.13, along with acceptable good blood pressure in the absence of antihypertensive medication (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Ubara et al. described one case of haemolytic uremic syndrome (HUS) in a patient undergoing treatment with INFB for 44 days for chronic hepatitis C.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Subsequently, Herrera et al. presented two cases of patients with thrombotic thrombocytopenic purpura (TTP), both of whom were being treated with INFB for periods of 2 and 4 weeks.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In our case, TTP was ruled out due to the absence of current neurological symptoms and to the fact that the ADAMTS13 activity and platelets were normal and thrombotic microangiopathy within accelerated hypertension.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Broughton et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and Olea et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> reported cases of TMA in patients undergoing treatment with INFB for MS, both of which were similar to the case reported here. Interferon treatment was discontinued and treatment with renin angiotensin system inhibitors was initiated.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The onset of hypertension or poorly controlled blood pressure has been previously described in patients undergoing INFB treatment, with the FDA describing 19 cases of hypertension out of 12,700 patients treated with INFB.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Modrego et al. reported a patient who had been treated for MS with INFB for many years and who was referred with poorly controlled hypertension and a renal biopsy compatible with kidney damage secondary to high blood pressure. The patient continued with treatment for hypertension after discontinuing INFB.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It is clear that there are many questions in relation to these associations, presently unresolved with the current literature. The pathogenesis of thrombotic microangiopathy in accelerated hypertension is not exactly known but is considered to play an important role in activating the renin–angiotensin–aldosterone system. In the case of our patient, is seems like arterial hypertension, kidney damage and thrombotic microangiopathy might be justified by treatment with interferon. However we cannot exclude that thrombotic microangiopathy is the cause by accelerated hypertension or the result of this one. Being difficult to assess which is the cause and which is the effect.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 975 "Tamanyo" => 118247 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fibrin thrombi occluding the glomerular capillary lumen. (A and B) Red Masson staining. X63. (C) Eosinophil with HE. X63. (D) Not stained with silver methenamine. X63.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Date \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hemoglobin (g/dL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Platelet (mmiles/uL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Creatinine (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LDH (IU/L) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Proteinuria (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">March 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">157 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">588 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">April 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">254 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">236 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">July 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">230 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">September 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">347 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">123 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1894090.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Blood test evolution.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemolytic uremic syndrome associated with beta-interferon therapy for chronic hepatitis C" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 11 | 15 |
| 2024 October | 39 | 39 | 78 |
| 2024 September | 46 | 33 | 79 |
| 2024 August | 60 | 51 | 111 |
| 2024 July | 29 | 30 | 59 |
| 2024 June | 54 | 30 | 84 |
| 2024 May | 49 | 51 | 100 |
| 2024 April | 34 | 29 | 63 |
| 2024 March | 41 | 25 | 66 |
| 2024 February | 36 | 34 | 70 |
| 2024 January | 33 | 26 | 59 |
| 2023 December | 22 | 28 | 50 |
| 2023 November | 26 | 28 | 54 |
| 2023 October | 37 | 22 | 59 |
| 2023 September | 27 | 25 | 52 |
| 2023 August | 27 | 15 | 42 |
| 2023 July | 45 | 23 | 68 |
| 2023 June | 38 | 28 | 66 |
| 2023 May | 35 | 30 | 65 |
| 2023 April | 37 | 17 | 54 |
| 2023 March | 44 | 17 | 61 |
| 2023 February | 44 | 16 | 60 |
| 2023 January | 39 | 21 | 60 |
| 2022 December | 51 | 28 | 79 |
| 2022 November | 42 | 22 | 64 |
| 2022 October | 108 | 44 | 152 |
| 2022 September | 39 | 43 | 82 |
| 2022 August | 44 | 48 | 92 |
| 2022 July | 35 | 47 | 82 |
| 2022 June | 46 | 29 | 75 |
| 2022 May | 49 | 37 | 86 |
| 2022 April | 42 | 56 | 98 |
| 2022 March | 40 | 46 | 86 |
| 2022 February | 52 | 35 | 87 |
| 2022 January | 76 | 34 | 110 |
| 2021 December | 55 | 52 | 107 |
| 2021 November | 46 | 37 | 83 |
| 2021 October | 50 | 38 | 88 |
| 2021 September | 44 | 38 | 82 |
| 2021 August | 56 | 45 | 101 |
| 2021 July | 89 | 28 | 117 |
| 2021 June | 30 | 29 | 59 |
| 2021 May | 48 | 45 | 93 |
| 2021 April | 165 | 74 | 239 |
| 2021 March | 64 | 29 | 93 |
| 2021 February | 36 | 29 | 65 |
| 2021 January | 47 | 23 | 70 |
| 2020 December | 28 | 23 | 51 |
| 2020 November | 39 | 16 | 55 |
| 2020 October | 29 | 28 | 57 |
| 2020 September | 35 | 20 | 55 |
| 2020 August | 44 | 11 | 55 |
| 2020 July | 41 | 21 | 62 |
| 2020 June | 48 | 12 | 60 |
| 2020 May | 57 | 16 | 73 |
| 2020 April | 22 | 16 | 38 |
| 2020 March | 32 | 13 | 45 |
| 2020 February | 26 | 18 | 44 |
| 2020 January | 32 | 21 | 53 |
| 2019 December | 34 | 26 | 60 |
| 2019 November | 46 | 18 | 64 |
| 2019 October | 23 | 12 | 35 |
| 2019 September | 26 | 17 | 43 |
| 2019 August | 29 | 19 | 48 |
| 2019 July | 27 | 27 | 54 |
| 2019 June | 25 | 22 | 47 |
| 2019 May | 35 | 25 | 60 |
| 2019 April | 42 | 66 | 108 |
| 2019 March | 24 | 18 | 42 |
| 2019 February | 27 | 24 | 51 |
| 2019 January | 29 | 35 | 64 |
| 2018 December | 63 | 48 | 111 |
| 2018 November | 38 | 12 | 50 |
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