Peracute primary malignant nephrosclerosis with irreversible kidney failure and malignant hypertension following ovulation inhibitors

Abstract

After brief treatment with 2 different estrogen-progestagen combinations, a previously normotensive 21-year-old woman developed malignant hypertension and progressive and irreversible renal failure. After 4 months of conservative treatment, bilateral nephrectomy was performed, normalizing the blood pressure. Nephrosclerosis was found in both kidneys. It was concluded that 1) oral contraceptives initiated a renal vascular process which was initially blood pressure independent and histologically described as malignant nephrosclerosis with secondary malignant hypertension and renal failure; 2) "primary" malignant nephrosclerosis should be differentiated from the "secondary" form, which results from accelerated hypertension; 3) the blood pressure should be checked regularly during the 1st months of oral contraceptive treatment.