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Renal Thrombotic Microangiopathy due to Hypertensive Emergency

Evan Perona1, Matthew Kornas1, Adrian G Dumitrascu1

  • 1Department of Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA.

Case Reports in Nephrology
|July 24, 2025
PubMed

Insights

Thrombotic microangiopathy (TMA) can cause acute kidney injury (AKI). This case report highlights hypertensive emergency as an underrecognized cause of TMA, emphasizing early diagnosis and blood pressure control for better patient outcomes.

Area of Science:

  • Nephrology
  • Hematology
  • Pathology

Background:

  • Thrombotic microangiopathy (TMA) is a serious condition characterized by microvascular thrombosis, microangiopathic hemolytic anemia (MAHA), and thrombocytopenia.
  • TMA can lead to acute kidney injury (AKI) due to renal microvasculature thrombosis and ischemic damage, necessitating prompt diagnosis and intervention to prevent irreversible renal harm.

Observation:

  • This case report focuses on hypertensive emergency as an underrecognized etiology of renal TMA.
  • The patient presented with TMA-associated AKI, exhibiting characteristic "onion-skin" lesions on renal pathology, indicative of schistocytes and tubular necrosis.

Findings:

  • Hypertensive emergency can precipitate TMA, leading to AKI.
  • Renal pathological imaging, specifically identifying schistocytes and tubular necrosis, is crucial for diagnosing TMA in hypertensive patients.
  • Early diagnosis and management, including blood pressure control, are vital for improving outcomes in TMA-associated AKI.

Implications:

  • Recognizing hypertensive emergency as a cause of TMA is critical for timely and appropriate patient management.
  • Integrating renal pathology into the workup of hypertensive crises with renal symptoms can aid in early TMA diagnosis.
  • Prompt diagnosis and management of TMA, particularly when linked to hypertensive emergencies, can be life-saving and prevent permanent kidney damage.

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