title: A case report of malignant hypertension in a young woman.
abstract: Malignant hypertension is a condition characterized by severe hypertension and multi-organ ischemic complications. Albeit mortality and renal survival have improved with antihypertensive therapy, progression to end-stage renal disease remains a significant cause of morbidity and mortality. The underlying cause of malignant hypertension, which can be primary or secondary hypertension, is often difficult to identify and this can substantially affect the treatment outcomes, as we report here.
  
  
  
  A 33-year-old woman presented with severe hypertension and acute renal failure. Initial evaluation demonstrated hyperreninemia with hyperaldosteronism and a possible renal artery stenosis at the contrast-enhanced CT scan. Although this data suggested the presence of a secondary form of hypertension, further exams excluded our first diagnosis of renal artery stenosis. Consequently, the patient did not undergo renal angiography (and the contrast media infusion associated with it), but she continued to be medically treated to achieve a tight blood pressure control. Our conservative approach was successful to induce renal function recovery over 2 years of follow-up.
  
  
  
  This case highlights the difficulty in differentiating between primary and secondary forms of malignant hypertension, particularly when the patient presents with acute renal failure. Clinicians should consider renal artery ultrasound as a first level diagnostic technique, given that the presentation of primary malignant hypertension can often mimic a renal artery stenosis. Secondly, adequate control of blood pressure is essential for kidney function recovery, although this may require a long time.
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Michelli
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, Trieste, Italy. stella.bernardi@aots.sanita.fvg.it.
authors.forename: Stella
authors.identifier: 0000-0002-7429-3075
authors.initials: S
authors.lastname: Bernardi
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Grillo
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, Trieste, Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Panizon
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, Trieste, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Rovina
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, Trieste, Italy.
authors.forename: Moreno
authors.initials: M
authors.lastname: Bardelli
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, Trieste, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Carretta
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fabris
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000075222:Essential Hypertension / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood; D006974:Hypertension, Malignant / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D012083:Renin / Q000097:blood
chemical_list: D000959:Antihypertensive Agents; D012083:Renin
keywords: Acute kidney injury; Malignant hypertension; Renin-angiotensin-aldosterone system; Young woman