Abstract
RATIONALE: Thrombotic microangiopathies (TMA) caused by malignant hypertension is an acute and critical disease among rare diseases. Although renal biopsy pathology is a golden indicator for diagnosing kidney disease, it cannot distinguish between primary and secondary TMA and requires a comprehensive diagnosis in conjunction with other laboratory tests and medical history. PATIENT CONCERNS: A 33-year-old young man was hospitalized due to unexplained kidney failure. DIAGNOSIS: A young man was admitted to the hospital with unexplained renal failure with severe heart failure and was diagnosed with TMA by renal biopsy. Further investigation excludes primary TMA and is considered to be due to malignant hypertension. INTERVENTIONS: Temporary hemodialysis combined with aggressive blood pressure control and the use of angiotensin receptor-neprilysin inhibitor are the primary management approach. OUTCOMES: Upon discharge, the patient had ceased dialysis and showed significant renal function recovery. After 1 year follow-up period, creatinine levels remained stable at 2.373 mg/dL, while lactate dehydrogenase, B-type natriuretic peptide, and platelet levels all returned to within normal ranges. LESSONS: TMA caused by malignant hypertension is rare and similar to the clinical manifestations of TMA caused by Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome, but it is often sudden and critical. Early identification and diagnosis and aggressive antihypertensive therapy, must be given to avoid end-stage renal disease, long-term maintenance of dialysis, and the financial burden of unnecessary plasmapheresis and potential side effects of glucocorticoids.