A mixed presentation of IgA nephropathy and malignant hypertension with histological thrombotic Microangiopathy

IgA Nephropathy (IgAN) is one of the most common causes of glomerulonephritis. Biopsy is necessary for definitive diagnosis, though due to variability in severity and progression patients may forego biopsy initially. However, certain clinical presentations and histopathological findings may be significant predictors of poor prognosis. We describe a case of IgAN initially presenting as malignant hypertension. Retrospective chart review suggested previous hospital encounters with features of IgAN, before loss to follow up. Subsequent biopsy evidence of co-occurrent IgA deposition and thrombotic microangiopathy were identified. The occurrence of severe hypertension and the aforementioned biopsy findings in IgAN are rare, and strong predictors of rapid progression to end-stage kidney disease. We briefly review the literature supporting this prognosis.