PS-R04-6: A CASE OF MALIGNANT NEPHROSCLEROSIS WITHDREW FROM TEMPORARY HEMODIALYS

Abstract

In the Case of AKI (acute renal injury) due to malignant hypertension, appropriate BP (Blood Pressure) management is important and sometimes requires hemodialysis. Here we report a 49-year-old female patient with malignant hypertension, AKI and acute pulmonary edema. She presented with severe hypertension (BP213/150 mmHg), high serum creatinine level (Cr12.74 mg/dL), congestive heart in chest radiographic findings and nerve head edema (Scheie: H4S3). There were no findings associated with renal artery stenosis. She was diagnosed as AKI due to malignant hypertension. Nicardipine continuous intravenous infusion was carried out for BP control and temporary hemodialysis had begun almost simultaneously. On Day 5 of admission, she had received oral Ca blocker and low dose of ACE inhibitor (temocapril). BP level remained stable thereafter. Nevertheless, oliguric renal failure lasted for several weeks. On Day 10 of admission, we performed renal biopsy and confirmed onion-skin-like intimal thickening and luminal narrowing findings. These were corresponded to malignant nephrosclerosis, not to chronic nephritic syndrome. We continued 2 times per week hemodialysis using the indwelling catheter after discharge. Her daily urinary output increased substantially day by day (over 1000 ml/day) and her serum creatinine level became less and less around Cr 4.0 mg/dL. This case withdrew temporary hemodialysis over a period of five months conclusively. In some cases, renal dysfunction is improved slowly in the long-term course by appropriate BP management. Accordingly, it is necessary to evaluate the possibility whether or not withdrawing from hemodialysis in the cases of AKI due to malignant hypertension.