Acute renal failure associated with malignant hypertension

History and clinical findings: A 37-year-old woman was referred to the interdisciplinary emergency room with a high blood pressure and headaches. She complained about nausea and vomiting. She has been treated for hypertension for approximately 9 years in an outpatient clinic. Investigations: The patient's blood pressure was elevated up to 248/132 mm Hg. Emergency laboratory test revealed high blood creatinine (19,29 mg/dl) and blood urea nitrogen (365 mg/dl) along with the decreased haemoglobin concentration and normal thrombocytes. Urinalysis showed a mild hematuria and proteinuria. The CT-scan and sonography of the abdomen showed no relevant renal artery stenosis or any relevant intestinal organ damages. Treatment and course: An immediate anti hypertensive medication was started in the emergency room, which resulted in a gradual decrease of blood pressure. Due to hypertension-induced acute renal failure, a hemodialytic treatment was initiated. After several sessions of hemodialysis, the levels of blood urea nitrogen and creatinine gradually decreased but remained elevated. The patient was included into the renal transplantation program due to the anuric renal failure. Conclusions: Acute renal failure associated with very high blood pressure and retinal bleedings is characteristics of malignant hypertension resulting frequently from pre-existing essential hypertension. In addition, uremia is a major cause of mortality in malignant hypertension. Excessive arterial pressure leads to endothelial damage of arterioles and capillaries. The ischemic collapse of glomerula promotes further irreversible renal injury, and eventually leads to a long-term hemodialysis or renal transplantation.