Malignant hypertension with protracted but not definitive oligoanuric acute kidney failure.

Abstract

Malignant hypertension (MHTN) is diagnosed when a patient presents with accelerated hypertension and multiorgan compromise including severe retinopathy. The renal manifestations may be oliguric renal failure or rapidly progressive renal failure. Oliguria in MHTN occurs as a consequence of malignant nephrosclerosis, microangiopathic haemolytic anemia, polyarteritis nodosa, lupus, acute cortical necrosis and scleroderma. However, acute kidney insufficiency (AKI) may be seen in the absence of systemic disease or of nephropathy. The clinical presentation of anuria with MHTN is rare, and in such situations renal recovery is unlikely. There are few case studies reporting reversible renal failure in MHTN [1–16]. A literature search supports the view that the entity of reversible anuric renal failure in MHTN is recognized by early clinical presentation (with anuria/oliguria), the presence of normal sized kidneys, normal main renal arteries and kidney biopsy without significant vascular changes. Herein, we report two such cases with anuria due to MHTN who recovered after remaining on haemodialysis for an average 2 months.