Thrombotic microangiopathy in patients with malignant hypertension
© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:38 |
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| Enthalten in: |
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association - 38(2023), 5 vom: 04. Mai, Seite 1217-1226 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cavero, Teresa [VerfasserIn] |
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| Links: |
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| Themen: |
Blood pressure |
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| Anmerkungen: |
Date Completed 05.05.2023 Date Revised 07.05.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/ndt/gfac248 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM345204921 |
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| 245 | 1 | 0 | |a Thrombotic microangiopathy in patients with malignant hypertension |
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| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a blood pressure | |
| 650 | 4 | |a kidney failure | |
| 650 | 4 | |a malignant hypertension | |
| 650 | 4 | |a thrombotic microangiopathy | |
| 700 | 1 | |a Auñón, Pilar |e verfasserin |4 aut | |
| 700 | 1 | |a Caravaca-Fontán, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Trujillo, Hernando |e verfasserin |4 aut | |
| 700 | 1 | |a Arjona, Emi |e verfasserin |4 aut | |
| 700 | 1 | |a Morales, Enrique |e verfasserin |4 aut | |
| 700 | 1 | |a Guillén, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Blasco, Miquel |e verfasserin |4 aut | |
| 700 | 1 | |a Rabasco, Cristina |e verfasserin |4 aut | |
| 700 | 1 | |a Espinosa, Mario |e verfasserin |4 aut | |
| 700 | 1 | |a Blanco, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Rodríguez-Magariños, Catuxa |e verfasserin |4 aut | |
| 700 | 1 | |a Cao, Mercedes |e verfasserin |4 aut | |
| 700 | 1 | |a Ávila, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Huerta, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Rubio, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Cabello, Virginia |e verfasserin |4 aut | |
| 700 | 1 | |a Barros, Xoana |e verfasserin |4 aut | |
| 700 | 1 | |a Goicoechea de Jorge, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Rodríguez de Córdoba, Santiago |e verfasserin |4 aut | |
| 700 | 1 | |a Praga, Manuel |e verfasserin |4 aut | |
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