Malignant hypertension as a rare cause of thrombotic microangiopathy associated with end-stage renal disease

Abstract

Malignant hypertension (MH) can precipitate and worsen renal thrombotic microangiopathy. Also, renal thrombotic microangiopathies (TMA) can cause malignant hypertension. Case reports regarding this clinical presentation are limited. A 36-year-old man presented with low urine output and bilateral leg swelling for five days with two episodes of haemoptysis. He was identified as a patient with hypertensive emergency with hypertension mediated organ damage (HMOD) in cardiac and renal functions with thrombotic microangiopathy. Renal biopsy revealed focal acute tubular injury with moderate tubulointerstitial nephritis and hypertensive vascular changes. Multiple anti-hypertensive medications were used for adequate blood pressure control. Despite that, the patient had worsening renal function, and eventually became dependent on haemodialysis. Malignant hypertension has to be considered as one of the aetiologies of TMA as it can lead to end-stage renal disease (ESRD) and poor outcomes. Diagnosis is difficult when both entities are presenting together.