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Pulmonary renal syndrome secondary to malignant hypertension
  1. Yamini Veeranki1,
  2. Sandhya Suresh2 and
  3. Ramprasad Elumalai2
  1. 1General Medicine, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
  2. 2Nephrology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
  1. Correspondence to Dr Yamini Veeranki; yaminiveeranki96{at}


A man in his early 30s presented with sudden-onset respiratory distress, haemoptysis and reduced urine output. He was in volume overload with a blood pressure recording of 240/180 mm Hg. Pulmonary renal syndrome was suspected and he was initiated on plasmapheresis, followed by steroid pulse therapy. Chest radiography and the presence of fragmented red cells on the peripheral smear were unexplained. These were later explained by hypertensive nephropathy and thrombotic microangiopathy changes on renal biopsy. His respiratory and haematological parameters improved with blood pressure control. Malignant hypertension closely resembles pulmonary renal syndrome, which must be remembered in order to avoid plasmapheresis and high-dose immunosuppressive therapy.

  • Hypertension
  • General guidance on prescribing
  • Respiratory system
  • Dialysis
  • Acute renal failure

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinicalimages, investigation results, drawing original diagrams and algorithms, and critical revision forimportant intellectual content: YV, SS and RE. The following authors gave final approval of the manuscript: YV, SS and RE.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.