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Case Report

Renal Thrombotic Microangiopathy Due to Malignant Hypertension

Venugopal A.V., Consultant, Department of Nephrology, Care Hospitals, Visakhapatnam, Andhra Pradesh 530002, India. , Harini Agnes1 , Venugopal A.V.2

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Indian Journal of Emergency Medicine 3(2):p 269-271, Jul-Dec 2017. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3217.19

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Abstract

Malignant hypertension (MHTN) is a hypertensive emergency with end organ dysfunction and MHTN presenting as renal thrombotic microangiopathy is rare. It is characterized by microangiopathic hemolysis, anemia, thrombocytopenia, indirect hyperbilirubinemia and variable degrees of renal failure apart from papilledema and acutely elevated blood pressure. The degree of renal failure may vary depending on the extent of endothelial damage and stimulation of renin angiotensin aldosterone system. Herein, we report a rare case of malignant hypertension in a young boy with renal TMA. He has bilateral papilledema and initial blood pressure of 210/100 mm of Hg. He has features of microangiopathic hemolysis and severe oliguric renal failure. His blood pressure was managed in Emergency Department with IV nitroglycerin and IV labetalol continuous infusion. He was instituted on hemodialysis through right Internal Jugular access and was continued on dialysis for the next two weeks. His blood pressure was managed with oral antihypertensives (Metaprolol (100mg/day), Nifedipine (60mg/day), Hydralazine (100mg/day), Torsemide 40mg/day). He showed good signs of improvement with adequately controlled blood pressure (140/80) and a stable renal function (Ser. Creat of 2.3 mg/dl, during last followup). Unlike Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome complex, renal TMA associated with malignant hypertension will not respond to plasmapheresis and adequate emergent management of blood pressure in emergency department will limit the extent of renal damage. The level of LDH, platelet count and hemoglobin can be used as markers of microangiopathic hemolysis. Renal recovery can vary from complete to partial recovery.

Keywrods: Malignant Hypertension; Mmicroangiopathic Hemolysis; Renal Failure. 

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3217.19

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