[Malignant hypertension presenting with renal damage: a clinical and pathological analyses]

To evaluate the clinical features and pathological characteristics of malignant hypertension (MHPT) with renal damage.

The blood pressure, eye ground, urinalysis, renal function and extrarenal presentations of malignant hypertension patients, who had been hospitalized in recent eleven years, were analyzed retrospectively. There were 27 patients, 21 males and 6 females, aged from 19 to 51 years. At the same time, the clinical and pathological features of primary MHPT were compared with those of renal parenchymal MHPT.

Among these patients, primary hypertension was diagnosed in 10 cases (37%), glomerulonephritis in 10 cases (37%), renovascular hypertension in 1 case (3.7%), and undetermined etiology in 6 cases (22.3%). The common renal presentations were those of rapidly progressive glomerulonephritis (RPGN) and progressive renal failure. Compared with those who were diagnosed as renal parenchymal MHPT, primary MHPT patients had lower urinary protein excretion (P = 0.001) and most of them had family history of hypertension. Renal biopsy was done in 13 cases, revealing primary MHPT in 4 cases and glomerulonephritis in 9. Typical pathological findings for primary MHPT were fibroid necrosis, marked intimal hyperplasia ("onion skin" like change) and ischemic changes of glomeruli. Severe glomerulonephritis, hyalinosis and thickening of renal arterioles were the main changes in MHPT with renal parenchymal diseases. After intensive therapy, the renal functions of some primary MHPT patients improved markedly.

Malignant hypertension presenting with renal damage was not very rare. It was usually misdiagnosed. The clinical presentations, pathological findings and prognosis of primary MHPT were different from those of renal parenchymal MHPT.