Primary vesicoureteral reflux presenting as hypertensive crisis and thrombotic microangiopathy

A 10-year-old boy with a history of febrile urinary tract infections presented with a hypertensive crisis and thrombotic microangiopathy (TMA). Functional and genetic complement testing was normal, and TMA resolved with blood pressure control, suggesting a primary hypertensive aetiology. Renal biopsy confirmed chronic tubulointerstitial nephritis (CTIN), likely secondary to recurrent pyelonephritis and renal scarring after ruling out other potential causes. High-grade vesicoureteral reflux was confirmed by voiding cystourethrography. After 4 years, he has progressed to stage III chronic kidney disease, and his blood pressure is well controlled on enalapril. This case highlights the importance of early diagnosis and blood pressure monitoring in patients with renal scarring to prevent severe complications like hypertensive crises and irreversible renal damage.