In May, 2009, a 17-year-old girl was admitted with a 10-day history of anorexia and vomiting. She had no significant medical or family history, and was on no medication other than the oral contraceptive pill. Examination was unremarkable, with normal blood pressure and volume status. She had severe non-oliguric renal impairment (urea 64 mmol/L, creatinine 1596 umol/L). Urinalysis showed haematuria and proteinuria. Full blood count showed macrocytic anaemia (haemoglobin 88 g/L, MCV 116 fL); blood film showed hypersegmented neutrophils. C-reactive protein concentration was 186 mg/L, lactate dehydrogenase was 1637 IU/L (normal 285-540), and clotting screen was normal. Ultrasonography showed normal sized unobstructed kidneys with prominent pyramids (figure A). There was no serological evidence of systemic lupus erythematosus or systemic vasculitis. Peritoneal dialysis was started. A percutaneous kidney biopsy showed that 90% of the cortex and cortical medulla was necrotic with histological evidence of fibrin in the intra-renal arterioles, consistent with microvascular thrombosis (figure B, C).
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机译：2009年5月，一名17岁女孩因厌食和呕吐的10天病史而入院。她没有明显的病史或家族史，除口服避孕药外，没有其他药物。检查没有异常，血压和体积状态正常。她患有严重的非少尿性肾功能不全（尿素64 mmol / L，肌酐1596 umol / L）。尿液分析显示血尿和蛋白尿。全血细胞计数显示大细胞性贫血（血红蛋白88 g / L，MCV 116 fL）;血膜显示中性粒细胞过度分裂。 C反应蛋白浓度为186 mg / L，乳酸脱氢酶为1637 IU / L（正常285-540），凝血筛查正常。超声检查显示正常大小的无阻塞肾脏，且金字塔突出（图A）。没有系统性红斑狼疮或系统性血管炎的血清学证据。开始腹膜透析。经皮肾活检显示，肾小动脉中纤维蛋白的组织学证据表明皮层和皮质髓质90％坏死，与微血管血栓形成一致（图B，C）。
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