A Case of Malignant Hypertension-Induced Thrombotic Microangiopathy with Gradually Improved Renal Function Using Appropriate Antihypertensives

Malignant hypertension sometimes causes microangiopathic hemolytic anemia (MAHA) and thrombotic microangiopathy (TMA). TMA results in the obstruction of arterioles and capillaries due to microvascular thrombosis. The pathological diagnosis of TMA is done by tissue biopsy. In this process, malignant hypertension-induced TMA must be distinguished from thrombotic thrombocytopenic purpura (TTP) and hemolitic uremic syndrome (HUS). We describe the case of a 45-year-old man with malignant hypertension, MAHA, and severe renal failure. Plasmapheresis was performed until the ADAMTS -13 activity was reported as normal. The patient’s blood pressure was reduced in a controlled manner first using antihypertensives, and TMA was confirmed by a kidney biopsy. Based on the normal ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity, other possible conditions that might cause TMA were eliminated, and malign hypertension-induced TMA was diagnosed. After two years, the glomerular filtration rate was found to have increased from 22 to 59.5 ml/min. In cases of severe hypertension associated with TMA, it may sometimes not be easy to establish whether TMA is caused by malignant hypertension or other associated diseases. The treatment of hypertension-induced TMA aims to control hypertension, which leads to the resolution of TMA over time.

Cite this article as: Bora F, Yılmaz F, Sözel H, Akkaya B. A Case of Malignant Hypertension-Induced Thrombotic Microangiopathy with Gradually Improved Renal Function Using Appropriate Antihypertensives. Turk J Nephrol 2021; 30(1): 77-9.