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Renal Histology Findings in Malignant Hypertension, a Systematic Review

Valentin Maisons1,2, Ferhat Demir3, Alexandre Fillon1

  • 1Department of Nephrology (V.M., A.F., P.D., B.S., J.-M.H.), CHU de Tours, France.

Hypertension (Dallas, Tex. : 1979)
|November 4, 2025
PubMed
Abstract

Insights

Malignant hypertension often involves kidney damage beyond nephrosclerosis, with thrombotic microangiopathy prevalent in most patients. Understanding these renal histopathology findings is crucial for improving patient outcomes.

Area of Science:

  • Nephrology
  • Cardiology
  • Pathology

Background:

  • Malignant hypertension (MH) causes severe target-organ damage, including kidneys.
  • Renal histopathology in MH is understudied due to bleeding risks associated with kidney biopsies.
  • The prevalence and characteristics of thrombotic microangiopathy in MH require further elucidation.

Purpose of the Study:

  • To systematically review and analyze renal histological findings in adult patients diagnosed with malignant hypertension.
  • To characterize the spectrum of kidney pathology associated with MH, with a focus on thrombotic microangiopathy.

Main Methods:

  • A systematic review adhering to PRISMA guidelines was conducted.
  • Searches were performed across major databases (PubMed, Embase, Cochrane Library, Web of Science).
  • Data on demographics, clinical presentation, and renal histology were extracted from eligible studies.

Main Results:

  • The analysis included 1781 patients from 144 studies, predominantly male (67%), with a mean age of 38.4 years.
  • Elevated serum creatinine (587.8 µmol/L) and proteinuria (4.3 g/g) were observed.
  • Nephrosclerosis was found in 68.4%, while thrombotic microangiopathy was highly prevalent (hematologic: 72.8%, renal: 95.2%), with increasing rates over time.

Conclusions:

  • A significant proportion of MH patients exhibit renal lesions beyond simple nephrosclerosis.
  • Hematologic and renal thrombotic microangiopathy are common in malignant hypertension, affecting two-thirds and nearly all patients, respectively.
  • Further research into complement pathways is recommended for improved prognosis and therapeutic strategies.
Keywords:
blood pressurehypertensionprognosisproteinuriathrombotic microangiopathy

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