Thrombotic microangiopathy in a young patient with malignant arterial hypertension: The possible role of chronic heat stress (A clinical observation)
Abstract. Thrombotic microangiopathy (TMA) is one of the manifestations of malignant arterial hypertension (MAH), requiring differential diagnosis from primary forms of the disease. This article describes a clinical case of TMA associated with MAH in a 38-year-old patient with prolonged exposure to high temperatures. The disease manifested with an increase in blood pressure (BP) to 212/120 mmHg and acute visual impairment. The patient had severe azotemia (creatinine level up to 350 μmol/L), proteinuria up to 1.75 g/day, and stage 3 hypertensive retinopathy. A kidney biopsy revealed signs of acute and chronic TMA, while complement-mediated forms of the disease were excluded. Combination antihypertensive therapy and heat stress management resulted in stabilization of blood pressure and renal function (creatinine 218–228 μmol/L, eGFR ≈ 31 mL/min/1.73 m²). Current observation demonstrates that TMA in young patients can remain to be asymptomatic for a long time. If TMA is detected, a thorough differential diagnosis is necessary. Renin-angiotensin-aldosterone system (RAAS) blockers may be prescribed even in cases of reduced eGFR, in case of its monitoring. Chronic heat stress can be considered to be a potential trigger for the disease.K.A Demyanova, N.L. Kozlovskaya, M.V. Khachatryan, A.S.E. Ojama Nchama, T.V. Bondarenko, Zh.D. Kobalava
Keywords
thrombotic microangiopathy
malignant hypertension
chronic heat stress
acute kidney injury
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About the Authors
Ksenia A. Demyanova, MD, PhD (Medicine), associate professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after V.S. Moiseyev, RUDN University; nephrologist at the Center for assistance to pregnants with kidney pathology, A.K. Eramischantsev City Clinical Hospital , Moscow, Russian FederationE-mail: ksedem@gmail.com
ORCID: https://orcid.org/0000-0001-8927-5841
Natalya L. Kozlovskaya, MD, Dr. Sci. (Medicine), professor, professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after V.S. Moiseyev, RUDN University; head of the Center for assistance to pregnants with kidney pathology, A.K. Eramischantsev City Clinical Hospital, Moscow, Russian Federation.
E-mail: nkozlovskaya@yandex.ru
ORCID: https://orcid.org/0000-0002-4275-0315
Milena V. Khachatryan, clinical resident of the Department of internal medicine with a course in cardiology and functional diagnostics named after V.S. Moiseyev, RUDN University, Moscow, Russian Federation.
E-mail: kha4atryan.milena@yandex.ru
ORCID: https://orcid.org/0009-0009-0915-7438
Alexia S.E. Ojama Nchama, MD, postgraduate student of the Department of internal medicine with a course in cardiology and functional diagnostics named after V.S. Moiseev, RUDN University, Moscow, Russian Federation.
E-mail: Alex.sinfo@mail.ru
ORCID: https://orcid.org/0009-0006-8367-2639
Tatyana V. Bondarenko, MD, head of the Interdistrict Center of Nephrology, head of the Department of nephrology, nephrologist at A.K. Eramischantsev City Clinical Hospital, Moscow. Russian Federation
E-mail: tatiana.v.bondarenko@mail.ru
ORCID: https://orcid.org/0000-0003-0701-1805
Zhanna D. Kobalava, MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev, RUDN University, E-mail: zkobalava@mail.ru
ORCID: https://orcid.org/0000-0002-5873-1768
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