A case of hypertensive emergency in a patient who had a history of very low birth weight

Abstract Low birth weight (LBW) is a risk factor for development of hypertension and chronic kidney disease in adulthood. Here, we report the case of a forty-year-old man with a history of very low birth weight (VLBW) (1300 g) who had hypertensive emergency (233/142 mmHg), acute kidney injury (AKI) (serum creatinine, 8.47 mg/dL), elevated plasma renin activity (102 ng/mL/h), and posterior reversible encephalopathy syndrome. He received temporary hemodialysis but was eventually liberated following intensive antihypertensive therapy. A renal biopsy revealed focal segmental glomerulosclerosis (FSGS) with endothelial injury. In addition, the patient had pre-existing, undertreated hypertension. Taken together, the reduced nephron number and impaired vascular development due to LBW may be involved in the development of adult-onset, near fatal hypertensive emergency and subsequent AKI in our case. This case reinforces the long-term cardio-renal risks associated with LBW and illustrates the importance of evaluating perinatal history in the diagnostic workup and successful management of adult-onset nephropathy.