Thrombotic microangiopathy in patients with malignant hypertension

Autor: Teresa Cavero, Pilar Auñón, Fernando Caravaca-Fontán, Hernando Trujillo, Emi Arjona, Enrique Morales, Elena Guillén, Miquel Blasco, Cristina Rabasco, Mario Espinosa, Marta Blanco, Catuxa Rodríguez-Magariños, Mercedes Cao, Ana Ávila, Ana Huerta, Esther Rubio, Virginia Cabello, Xoana Barros, Elena Goicoechea de Jorge, Santiago Rodríguez de Córdoba, Manuel Praga
Rok vydání: 2022
Předmět:
Zdroj: NEPHROLOGY DIALYSIS TRANSPLANTATION
r-FISABIO. Repositorio Institucional de Producción Científica
instname
ISSN: 1460-2385
0931-0509
Popis: Background Thrombotic microangiopathy (TMA) is a complication of malignant hypertension (mHTN) attributed to high blood pressure (BP). However, no studies have investigated in patients with mHTN of different aetiologies whether the presence of TMA is associated with specific causes of mHTN. Methods We investigated the presence of TMA (microangiopathic haemolytic anaemia and thrombocytopenia) in a large and well-characterized cohort of 199 patients with mHTN of different aetiologies [primary HTN 44%, glomerular diseases 16.6%, primary atypical haemolytic uraemic syndrome (aHUS) 13.1%, renovascular HTN 9.5%, drug-related HTN 7%, systemic diseases 5.5%, endocrine diseases 4.5%]. Outcomes of the study were kidney recovery and kidney failure. Results Patients with TMA [40 cases (20.1%)] were younger, were more likely female and had lower BP levels and worse kidney function at presentation. Their underlying diseases were primary aHUS (60%), drug-related mHTN (15%), glomerular diseases [all of them immunoglobulin A nephropathy (IgAN); 10%], systemic diseases (10%) and primary HTN (5%). The presence of TMA was 92.3% in primary aHUS, 42.9% in drug-related HTN, 36.4% in systemic diseases, 12.1% in glomerular diseases and 2.3% in primary HTN. No patient with renovascular HTN or mHTN caused by endocrine diseases developed TMA, despite BP levels as high as patients with TMA. A higher proportion of TMA patients developed kidney failure as compared with patients without TMA (56.4% versus 38.9%, respectively). Conclusions The presence of TMA in patients with mHTN should guide the diagnosis towards primary aHUS, drug-related mHTN, some systemic diseases and IgAN, while it is exceptional in other causes of mHTN.
Databáze: OpenAIRE
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