SHM Converge Scientific Abstract ePoster Gallery-When Blood Pressure Breaks the Body: Chronic Tma Hidden Beneath Malignant Hypertension

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The document describes a case of chronic thrombotic microangiopathy (TMA) caused by malignant hypertension in a 33-year-old woman with stage 4 chronic kidney disease, obesity, and medication nonadherence. She presented with severe shortness of breath, pulmonary edema, and extremely elevated blood pressure (246/166 mmHg) after missing antihypertensive medications for a week. Laboratory studies showed advanced renal failure, anemia, proteinuria, hypoalbuminemia, and electrolyte abnormalities. Despite ICU treatment with nicardipine, diuretics, and eventual hemodialysis, her kidney function did not recover and she progressed to end-stage renal disease (ESRD).<br /><br />A kidney biopsy revealed extensive chronic injury, including global glomerulosclerosis, severe interstitial fibrosis and tubular atrophy, and findings consistent with chronic TMA, hypertensive nephrosclerosis, and secondary focal segmental glomerulosclerosis (FSGS). Workup for other causes of secondary hypertension was negative, and preserved ADAMTS13 activity plus lack of major thrombocytopenia supported hypertension-induced TMA rather than primary TMA.<br /><br />Her condition also affected the brain: she developed blurry vision, and MRI showed white matter hyperintensities and a small diffusion-restricted lesion consistent with hypertensive microvascular infarcts. These findings suggested systemic small-vessel damage from long-standing uncontrolled hypertension. She was started on aspirin after neurologic evaluation.<br /><br />The case highlights that malignant hypertension-associated TMA is rare but highly dangerous, often leading to irreversible kidney damage and poor prognosis. Early recognition, aggressive blood pressure control, and close follow-up are essential to prevent ESRD, stroke, and other end-organ complications.

Asset Subtitle

Kunal Jain

Meta Tag

Author List Arshia Iqbal, Ilsa Haidry, Kunal Jain, Mahnoor Khalid, Supriya Sekhar, Venkata Mukku

Category Clinical Vignettes

Concept Thrombotic Microangiopathy

Concept Malignant Hypertension

Concept Hypertensive Emergency

Concept Urgent Blood Pressure Control

Concept Endothelial Injury

Distinguished Non-Finalist

Presenter Organization Texas Health Resources

Presenting Author Kunal Jain

Track Adult

Keywords

malignant hypertension

thrombotic microangiopathy

chronic kidney disease

end-stage renal disease

kidney biopsy

hypertensive nephrosclerosis

focal segmental glomerulosclerosis

pulmonary edema

ADAMTS13 activity

microvascular infarcts

Thrombotic Microangiopathy

Malignant Hypertension

Hypertensive Emergency

Urgent Blood Pressure Control

Endothelial Injury