Key result
Conservative medical therapy normalizes blood pressure and restores renal function over 2 years in malignant hypertension.
Why the study?
The underlying cause of malignant hypertension is often difficult to identify, which can substantially affect treatment outcomes, especially in patients presenting with acute renal failure.
Case Report (n=1)
In a young woman with malignant hypertension and acute renal failure, renal duplex ultrasound helped exclude renal artery stenosis, allowing for successful conservative medical management and avoiding potentially harmful contrast media.
May support conservative management after excluding renovascular disease in malignant hypertension with AKI; single case leaves generalizability open.
BACKGROUND: Malignant hypertension is a condition characterized by severe hypertension and multi-organ ischemic complications. Albeit mortality and renal survival have improved with antihypertensive therapy, progression to end-stage renal disease remains a significant cause of morbidity and mortality. The underlying cause of malignant hypertension, which can be primary or secondary hypertension, is often difficult to identify and this can substantially affect the treatment outcomes, as we report here. CASE PRESENTATION: A 33-year-old woman presented with severe hypertension and acute renal failure. Initial evaluation demonstrated hyperreninemia with hyperaldosteronism and a possible renal artery stenosis at the contrast-enhanced CT scan. Although this data suggested the presence of a secondary form of hypertension, further exams excluded our first diagnosis of renal artery stenosis. Consequently, the patient did not undergo renal angiography (and the contrast media infusion associated with it), but she continued to be medically treated to achieve a tight blood pressure control. Our conservative approach was successful to induce renal function recovery over 2 years of follow-up. CONCLUSION: This case highlights the difficulty in differentiating between primary and secondary forms of malignant hypertension, particularly when the patient presents with acute renal failure. Clinicians should consider renal artery ultrasound as a first level diagnostic technique, given that the presentation of primary malignant hypertension can often mimic a renal artery stenosis. Secondly, adequate control of blood pressure is essential for kidney function recovery, although this may require a long time.
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Michelli et al. (2016) conducted a case report in Malignant hypertension with acute renal failure (n=1). Conservative medical therapy (antihypertensive drugs) was evaluated on Blood pressure control and renal function recovery. Conservative medical therapy successfully induced blood pressure normalization and progressive renal function recovery over 2 years of follow-up in a young woman with malignant hypertension.
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